Reviewer ’s report  
 
Title: Mesenteric inflammatory veno -occlusive disease occurring during the course of ulcerative 
colitis: A case report.  
 
Version: 1 Date: 13 Nov 2017  
 
Reviewer: Heyson Chan  
 
Reviewer's report:  
 
Yamada and colleagues reported a rare case of mesenteric inflammatory veno -occlusive disease 
(MIVOD) in the setting of ulcerative colitis (UC). This raised the awareness of this as a 
differential diagnosis of patients with suspected UC flare.  
While this case report carries some credit, there are a num ber of issues that the authors have to 
revise before this paper is suitable for consideration for publication. One major crucial flaw of 
this case report is that some of the references they quoted were not able to support their 
respective quoted statements . Other issues are stated as follow:  
 
Introduction:  
- Please quote the references to support the statements "MIVOD is mostly resistant to medical 
treatment, as anticoagulants and immunoregulatory drugs have proven ineffective for 
patients with MIVOD" and "I n most cases, surgical resection of the involved bowel is 
required and prognosis is typically excellent"  
 
Case presentation:  
- There is inconsistency in the age of the patient in the abstract and the case presentation. 
Does the authors mean that the patient  was 29 years old when he first presented in the case 
presentation section? The authors should consider specifying that this sentence refer to the 
initial presentation 3 years ago rather than this episode.  
- It was stated that the patient was diagnosed wit h moderate UC and his symptoms was 
"relatively" controlled with oral 5ASA, did the patient achieved clinical remission or still 
having clinical symptoms before the flare? Was there any endoscopic assessment?  
- Consider a new paragraph to describe the flar e at age 32  
- Consider elaborating the symptoms experienced by the patient during the possible flare. Was 
there any PR bleeding? Did the patient fit the definition of severe flare by Truelove criteria?  
- In the sentence, "Basal plasmacytosis and eosinophil  infiltration were unremarkable and 
there was no typical "owl eye" inclusion indicating CMV infection (Fig.3a)." Do the authors 
mean Fig 3b instead?  
- What was done to exclude other possible differential diagnosis e.g.  Buerger's disease, 
Behçet's disease,  rheumatoid arthritis and systemic lupus erythematosus?  
- Please include the latest medication of the patient after surgery.  
 
Discussion:  
- It was mentioned that CMV was excluded at the presentation. However, in the post -
operative period, the patient was co mplicated with CMV infection. How was the post -
operative CMV infection diagnosed and how was it being treated?  
- It was quoted that "Previous reports indicate three cases of suspected MIVOD with UC. All 
of these cases had left -side colonic lesions and fail ed to respond to the appropriate treatment 
for UC, leading to required colectomy one to two weeks after the initial treatment" with 
reference 11 and 14. In the two cases of reference 11, the first patient was actually initially 
thought to be UC but was dia gnosed with protein S deficiency - so this patient is actually 
NOT having ulcerative colitis. The second patient was actually having Clostridium difficle 
infection and was never diagnosed UC. The authors may wish to go over the paper in detail 
and clarify if the statement can be supported by the reference they have quoted. The case 
presented in reference 14 also appeared not to be related to UC - please check.  
- This case of MIVOD occurred in the course of UC and MIVOD was confirmed at day 35 of 
UC flare by  the histological specimen from the colectomy. The patient did not have any 
imaging evidence of MIVOD at the initial presentation of the suspected flare up of UC. 
With the 35 -day delay in the diagnosis of MIVOD and the initial imaging, it is hard to 
conclu de whether the imaging failed to pick up the MIVOD or whether MIVOD occurred as 
a consequence of the hypercoagulable status from UC flare. The author should address this 
in their discussion.  
 
Overall:  
- The authors may wish to add a timeline to illustrate t he event sequence  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are requir ed in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the qualit y of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years receive d reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way ga in or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or sala ry from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answ er no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be ma de available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Mesenteric inflammatory veno -occlusive disease occurring during the course of ulcerative 
colitis: A case report.  
 
Version: 1 Date: 13 Nov 2017  
 
Reviewer: Heyson Chan  
 
Reviewer's report:  
 
Yamada and colleagues reported a rare case of mesenteric inflammatory veno -occlusive disease 
(MIVOD) in the setting of ulcerative colitis (UC). This raised the awareness of this as a 
differential diagnosis of patients with suspected UC flare.  
While this case report carries some credit, there are a num ber of issues that the authors have to 
revise before this paper is suitable for consideration for publication. One major crucial flaw of 
this case report is that some of the references they quoted were not able to support their 
respective quoted statements . Other issues are stated as follow:  
 
Introduction:  
- Please quote the references to support the statements "MIVOD is mostly resistant to medical 
treatment, as anticoagulants and immunoregulatory drugs have proven ineffective for 
patients with MIVOD" and "I n most cases, surgical resection of the involved bowel is 
required and prognosis is typically excellent"  
 
Case presentation:  
- There is inconsistency in the age of the patient in the abstract and the case presentation. 
Does the authors mean that the patient  was 29 years old when he first presented in the case 
presentation section? The authors should consider specifying that this sentence refer to the 
initial presentation 3 years ago rather than this episode.  
- It was stated that the patient was diagnosed wit h moderate UC and his symptoms was 
"relatively" controlled with oral 5ASA, did the patient achieved clinical remission or still 
having clinical symptoms before the flare? Was there any endoscopic assessment?  
- Consider a new paragraph to describe the flar e at age 32  
- Consider elaborating the symptoms experienced by the patient during the possible flare. Was 
there any PR bleeding? Did the patient fit the definition of severe flare by Truelove criteria?  
- In the sentence, "Basal plasmacytosis and eosinophil  infiltration were unremarkable and 
there was no typical "owl eye" inclusion indicating CMV infection (Fig.3a)." Do the authors 
mean Fig 3b instead?  
- What was done to exclude other possible differential diagnosis e.g.  Buerger's disease, 
Behçet's disease,  rheumatoid arthritis and systemic lupus erythematosus?  
- Please include the latest medication of the patient after surgery.  
 
Discussion:  
- It was mentioned that CMV was excluded at the presentation. However, in the post -
operative period, the patient was co mplicated with CMV infection. How was the post -
operative CMV infection diagnosed and how was it being treated?  
- It was quoted that "Previous reports indicate three cases of suspected MIVOD with UC. All 
of these cases had left -side colonic lesions and fail ed to respond to the appropriate treatment 
for UC, leading to required colectomy one to two weeks after the initial treatment" with 
reference 11 and 14. In the two cases of reference 11, the first patient was actually initially 
thought to be UC but was dia gnosed with protein S deficiency - so this patient is actually 
NOT having ulcerative colitis. The second patient was actually having Clostridium difficle 
infection and was never diagnosed UC. The authors may wish to go over the paper in detail 
and clarify if the statement can be supported by the reference they have quoted. The case 
presented in reference 14 also appeared not to be related to UC - please check.  
- This case of MIVOD occurred in the course of UC and MIVOD was confirmed at day 35 of 
UC flare by  the histological specimen from the colectomy. The patient did not have any 
imaging evidence of MIVOD at the initial presentation of the suspected flare up of UC. 
With the 35 -day delay in the diagnosis of MIVOD and the initial imaging, it is hard to 
conclu de whether the imaging failed to pick up the MIVOD or whether MIVOD occurred as 
a consequence of the hypercoagulable status from UC flare. The author should address this 
in their discussion.  
 
Overall:  
- The authors may wish to add a timeline to illustrate t he event sequence  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are requir ed in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the qualit y of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years receive d reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way ga in or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or sala ry from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answ er no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be ma de available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Mesenteric inflammatory veno -occlusive disease occurring during the course of ulcerative 
colitis: A case report.  
 
Version: 1 Date: 13 Nov 2017  
 
Reviewer: Heyson Chan  
 
Reviewer's report:  
 
Yamada and colleagues reported a rare case of mesenteric inflammatory veno -occlusive disease 
(MIVOD) in the setting of ulcerative colitis (UC). This raised the awareness of this as a 
differential diagnosis of patients with suspected UC flare.  
While this case report carries some credit, there are a num ber of issues that the authors have to 
revise before this paper is suitable for consideration for publication. One major crucial flaw of 
this case report is that some of the references they quoted were not able to support their 
respective quoted statements . Other issues are stated as follow:  
 
Introduction:  
- Please quote the references to support the statements "MIVOD is mostly resistant to medical 
treatment, as anticoagulants and immunoregulatory drugs have proven ineffective for 
patients with MIVOD" and "I n most cases, surgical resection of the involved bowel is 
required and prognosis is typically excellent"  
 
Case presentation:  
- There is inconsistency in the age of the patient in the abstract and the case presentation. 
Does the authors mean that the patient  was 29 years old when he first presented in the case 
presentation section? The authors should consider specifying that this sentence refer to the 
initial presentation 3 years ago rather than this episode.  
- It was stated that the patient was diagnosed wit h moderate UC and his symptoms was 
"relatively" controlled with oral 5ASA, did the patient achieved clinical remission or still 
having clinical symptoms before the flare? Was there any endoscopic assessment?  
- Consider a new paragraph to describe the flar e at age 32  
- Consider elaborating the symptoms experienced by the patient during the possible flare. Was 
there any PR bleeding? Did the patient fit the definition of severe flare by Truelove criteria?  
- In the sentence, "Basal plasmacytosis and eosinophil  infiltration were unremarkable and 
there was no typical "owl eye" inclusion indicating CMV infection (Fig.3a)." Do the authors 
mean Fig 3b instead?  
- What was done to exclude other possible differential diagnosis e.g.  Buerger's disease, 
Behçet's disease,  rheumatoid arthritis and systemic lupus erythematosus?  
- Please include the latest medication of the patient after surgery.  
 
Discussion:  
- It was mentioned that CMV was excluded at the presentation. However, in the post -
operative period, the patient was co mplicated with CMV infection. How was the post -
operative CMV infection diagnosed and how was it being treated?  
- It was quoted that "Previous reports indicate three cases of suspected MIVOD with UC. All 
of these cases had left -side colonic lesions and fail ed to respond to the appropriate treatment 
for UC, leading to required colectomy one to two weeks after the initial treatment" with 
reference 11 and 14. In the two cases of reference 11, the first patient was actually initially 
thought to be UC but was dia gnosed with protein S deficiency - so this patient is actually 
NOT having ulcerative colitis. The second patient was actually having Clostridium difficle 
infection and was never diagnosed UC. The authors may wish to go over the paper in detail 
and clarify if the statement can be supported by the reference they have quoted. The case 
presented in reference 14 also appeared not to be related to UC - please check.  
- This case of MIVOD occurred in the course of UC and MIVOD was confirmed at day 35 of 
UC flare by  the histological specimen from the colectomy. The patient did not have any 
imaging evidence of MIVOD at the initial presentation of the suspected flare up of UC. 
With the 35 -day delay in the diagnosis of MIVOD and the initial imaging, it is hard to 
conclu de whether the imaging failed to pick up the MIVOD or whether MIVOD occurred as 
a consequence of the hypercoagulable status from UC flare. The author should address this 
in their discussion.  
 
Overall:  
- The authors may wish to add a timeline to illustrate t he event sequence  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are requir ed in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the qualit y of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years receive d reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way ga in or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or sala ry from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answ er no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be ma de available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant