Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients

AGA Clinical Practice Update on Sclerosing Mesenteritis: Commentary

DESCRIPTION

The purpose of this American Gastroenterological Association Institute Clinical Practice Update is to review the available evidence for diagnosing and treating, as well as examine opportunities for future research in, sclerosing mesenteritis.

METHODS

This Clinical Practice Update expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important and recently published studies in this field, and it reflects the experiences of the authors who are gastroenterologists with expertise in this topic.

Acute total intestinal volvulus caused by sclerosing mesenteritis: a case report and review of the literature

BACKGROUND

Intestinal volvulus arises from the twisting of an intestinal loop around a fixed axis. This condition is distinguished by both the obstruction and constriction of the intestinal lumen, as well as the entrapment of intestinal blood vessels. Consequently, the intestinal obstruction resulting from volvulus is often of the strangulating variety, which poses a risk for swift intestinal necrosis. Mesenteric tumors are a notable precipitant of volvulus. However, certain nontumor lesions originating from the mesentery can also lead to severe intestinal volvulus.

CASE PRESENTATION

A 68-year-old Chinese female individual was hospitalized because of severe abdominal pain that occurred 6 h after engaging in physical labor. An abdominal computed tomography examination revealed volvulus of the mesenteric root and the presence of a mixed-density mass in the right mesentery, with the possibility of a neoplastic process not ruled out. Emergency surgical exploration confirmed that the small mesenteric tumor served as a pivot, with the mesenteric root twisted 1440°, leading to total necrosis of the small intestine. As a result, total small intestine resection and enterostomy were performed. Postoperative pathological examination of the mesenteric tumor revealed fat necrosis, excessive calcification, peripheral fibrous tissue hyperplasia, and chronic inflammatory cell infiltration, consistent with a diagnosis of sclerosing mesenteritis. The patient's life was saved through timely surgical intervention. However, owing to the development of short bowel syndrome, she will require long-term dependence on parenteral nutrition.

CONCLUSION

Intestinal volvulus due to sclerosing mesenteric inflammation is an exceedingly rare occurrence. Clinicians should maintain a high index of suspicion for this condition when encountering cases of intestinal volvulus attributed to mesenteric tumors. Prompt and decisive surgical intervention is crucial for saving lives and for preserving as much of the intestinal tract as possible.

Sclerosing Mesenteritis Presenting as Hilar Cholangiocarcinoma Causing Recurrent Chylous Ascites and Gastric Outlet Obstruction

Sclerosing mesenteritis is a rare spectrum of disease that results in chronic inflammation and fibrosis of the abdominal mesentery. Its heterogeneous presentation, nondiagnostic imaging, and pathology findings make diagnosis challenging. In this study, we present the first reported case of hilar sclerosing mesenteritis resulting in chylous ascites, gastric outlet obstruction, and duodenal perforation. Diagnosis was made after extensive investigations including computed tomography imaging, magnetic resonance cholangiopancreatography, positron emission tomography scan, bidirectional endoscopy, endoscopic ultrasound, and diagnostic laparoscopy. While initially mistaken for hilar cholangiocarcinoma, the patient has significant clinical improvement with corticosteroids and now remains in symptomatic and radiographic remission on low-dose prednisone and tamoxifen.

Mesenteric Panniculitis in a Renal Transplant Patient With Systemic Lupus Erythematosus

Mesenteric panniculitis (MP) is a disease of unknown etiology, causing fibrosis of the small bowel mesentery. MP is typically diagnosed incidentally with computed tomography imaging but is occasionally associated with surgery, trauma, and cancer. The prevalence of MP varies across the literature; however, it is agreed upon to be a rare diagnosis. This case describes a 34-year-old female with systemic lupus erythematosus (SLE) who presented with abdominal symptoms and was later found to have MP. We postulated that the patient's SLE flare and adjustment in immunosuppressive medications facilitated the development of MP. This case highlights the need for further research regarding the association of MP and autoimmune conditions such as SLE.

Mesenteric panniculitis: A case report

INTRODUCTION AND IMPORTANCE

Mesenteric panniculitis is a rare, benign condition characterized by chronic inflammation and fibrosis of mesenteric adipose tissue (Hussein and Abdelwahed, 2015; Gögebakan et al., 2018 [1, 2]). While its etiology remains unclear in many cases, it has been associated with various conditions including abdominal surgery, trauma, and inflammatory diseases (Buragina et al., 2019 [3]). Understanding its presentation and management is crucial for proper patient care.

CASE PRESENTATION

We present a case of mesenteric panniculitis in a 49-year-old woman who presented with significant weight loss. The diagnosis was confirmed through imaging studies and tissue biopsy, with successful symptomatic management through conservative treatment.

CLINICAL DISCUSSION

The condition typically presents with nonspecific symptoms including abdominal pain, nausea, and weight loss, though it may be discovered incidentally. Diagnosis relies on a combination of imaging findings, particularly the characteristic "misty mesentery" appearance on CT scan, and when indicated, histological confirmation.

CONCLUSION

Early recognition and appropriate management of mesenteric panniculitis are essential for optimal outcomes. While usually benign, the condition requires thorough evaluation to exclude underlying malignancy and careful monitoring to prevent complications.

Sclerosing Mesenteritis Presenting as Intestinal Occlusion: A Case Report

Sclerosing mesenteritis is a chronic disease that primarily affects the mesenteric adipose tissue and encompasses a range of fibrotic and inflammatory pathologies. Due to its low incidence, the etiology remains unclear, though various factors are thought to contribute to its onset. Clinical manifestations are nonspecific, ranging from asymptomatic cases to persistent abdominal pain, which is the most common symptom. Incidental findings on imaging have increased with the widespread use of computed tomography (CT) scans. However, the diagnosis remains histological. Sclerosing mesenteritis is mainly associated with a good prognosis, as it typically follows a benign clinical course and rarely presents with complications or persistent symptoms. In this article, the authors present a clinical case of an 82-year-old male patient who presented with abdominal pain, constipation, and vomiting. The patient underwent an urgent laparotomy for intestinal occlusion. Histological examination confirmed sclerosing mesenteritis. Due to its limited understanding, sclerosing mesenteritis is often misdiagnosed. It should be considered as a differential diagnosis, particularly in patients with poorly defined abdominal pain, normal laboratory studies, and nonspecific imaging findings, to avoid unnecessary treatments. Nonetheless, urgent surgical intervention may be necessary in cases presenting with intestinal occlusion or uncontrolled pain.

Upper and Lower Endoscopic Findings in Mesenteric Panniculitis Patients: A Case-Control Study

Background: The natural history and prognosis of mesenteric panniculitis (MP) are not well-described. Despite referral for colonoscopy being common for this indication, colonoscopy findings in MP patients have not been reported. Therefore, we aimed to describe upper and lower gastrointestinal (GI) endoscopy findings in patients with mesenteric panniculitis, compared to matched controls, to investigate their clinical outcomes including incidence of malignancy and mortality. Methods: Retrospective case-control study was conducted, and included patients who were diagnosed with mesenteric panniculitis according to Coulier radiologic criteria on abdominal computerized tomography between 1/2005 and 12/2019, and followed to 12/2021. The case group was compared to a matched control group without MP on abdominal CT. Clinical data and the upper and lower endoscopies' reports were reviewed in both groups. We excluded patients who, beyond diagnosis of MP, were also diagnosed with current malignancy, significant intra-abdominal morbidity or inflammatory bowel disease. Results: The initial set of 376 patients with MP, after exclusion, included 187 patients. A total of 56.1% were male, with a mean age 60 ± 15 years. Of them, 74 (39%) patients underwent follow-up CT scans, which demonstrated, in 66 (89.2%) patients, a stable MP without any aggravation. Colonoscopy was performed in 89 MP patients, and 98/187 controls. No significant difference in the colonoscopies' findings was found between the two groups. Gastroscopy was performed in 84 MP and 79 controls. No case of gastric cancer was found. No statistically significant difference was found in the rate of gastroscopy findings. By the end of the follow-up period, malignancy was diagnosed in four patients of the MP group. None were colon cancer. The mortality rate in the MP group was 3.2%, without a significant difference compared to the controls. None were MP related. Conclusions: MP identified on abdominal CT is not associated with pathologic endoscopy findings or future diagnosis of colon cancer, and also has no impact on mortality rate. Since repeating abdominal CT did not reveal any disease progression, the necessity of follow-up imaging for MP should be carefully reconsidered.

Relapsing sclerosing mesenteritis with multiple strictures of the small intestine

Sclerosing mesenteritis (SM) is a rare disorder that involves the mesenteric adipose tissue with chronic fibrosing inflammation. Few reports mention the natural history of severe SM cases. Here, we report a severe and relapsing SM case in which a long-term natural history could be followed. The patient had undergone surgery for small bowel stenosis of unknown cause 10 years earlier. He had stopped visiting the hospital at his discretion. He was admitted to the hospital 10 years later due to recurrent symptoms, and a close examination revealed multiple small intestinal strictures; thus, surgery was performed again. The pathological results revealed that the patient had SM, corticosteroid administration dramatically improved his symptoms, and he has maintained remission for a long time.

The Long-Term (3.5-Year) Observation of Asymptomatic Sclerosing Mesenteritis: A Case Report

A 57-year-old male with a history of hypertension, diabetes mellitus, and dyslipidemia was found to have elevated carcinoembryonic antigen (CEA) levels during a routine health checkup, leading to an abdominal computed tomography (CT) scan. The scan identified a mesenteric mass with an irregular morphology. Subsequent blood tests indicated no signs of inflammation, and follow-up CEA levels normalized. Further imaging with abdominal contrast-enhanced CT and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT revealed a calcified mass in the mesentery, raising concerns for malignancy. However, an exploratory laparotomy and biopsy confirmed the diagnosis of sclerosing mesenteritis (SM). During a 3.5-year period, the patient remained asymptomatic, with serial imaging showing no significant changes in the mass, even without treatment. This case underscores the potential benign course of SM, suggesting that conservative management may be appropriate in select asymptomatic cases.

Sclerosing mesenteritis as a cause of porto-mesenteric vascular obstruction

A woman in her 20s presented with haematemesis, post-prandial abdominal pain, weight loss and anaemia. Imaging revealed a non-enhancing mass in the retroperitoneal space along the mesenteric plane, encasing the porto-mesenteric vasculature. Endoscopy showed oesophageal varices. She was diagnosed with sclerosing mesenteritis, causing extrinsic compression of the portal vein and superior mesenteric artery. She underwent endoscopic variceal ligation and received prednisolone and tamoxifen. After 3 months, her post-prandial pain improved, and she did not have further bleeding episodes.

Fibrotic phenotype of IgG4-related disease

A prompt response to glucocorticoids is a clinical hallmark of IgG4-related disease. However, manifestations characterised by prominent tissue fibrosis on histological examination can be less responsive to glucocorticoid therapy than other types of IgG4-related disease. These manifestations include retroperitoneal fibrosis, fibrosing mediastinitis, Riedel thyroiditis, orbital pseudotumor, and hypertrophic pachymeningitis, among others. To explain this discrepancy, a preliminary distinction into proliferative and fibrotic phenotypes of IgG4-related disease has been proposed on the basis of clinical presentation, pathological features, and response to immunosuppressive therapy. Implications of this classification for patient management remain an important area of investigation. In this Series paper, we aim to dissect the pathophysiology of tissue fibrosis in IgG4-related disease and discuss how clinicians should approach the management of fibrotic manifestations of IgG4-related disease based on the most recent diagnostic and therapeutic developments.

Sclerosing Mesenteritis Presenting With Small Bowel Obstruction in a Patient With Systemic Lupus Erythematosus: A Case Report

Sclerosing mesenteritis (SM) is a rare inflammatory disorder characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue. While SM can manifest with various gastrointestinal symptoms, its association with small bowel obstruction (SBO) is infrequent. We present a case of a 78-year-old male with a history of systemic lupus erythematosus (SLE) who presented with acute abdominal pain and distention. The patient had multiple admissions with the same symptoms. A CT scan showed swirling of the proximal central mesentery, small bowel malrotation with volvulus, and high-grade mechanical obstruction of the proximal jejunum. The patient underwent exploratory laparotomy, with findings significant for multiple inflammatory nodules in the mesentery. These were causing adhesions between the bowel and mesentery, resulting in a volvulus of the bowel. One segment was resected, and subsequent histopathological examination revealed subserosal fibrosis and chronic inflammation. The clinical scenario was consistent with a diagnosis of SM. This case highlights the challenges of diagnosing and managing SBO in the presence of SM and SLE. Further research is needed to understand the underlying pathophysiological mechanisms and improve management techniques for this rare clinical condition.

Sclerosing Mesenteritis: A Concise Clinical Review for Clinicians

Sclerosing mesenteritis (SM), an idiopathic nonneoplastic condition affecting 0.18% to 3.14% of the population, is characterized by chronic fat necrosis, inflammation, and fibrosis most commonly of the mesentery of the small intestine. Sclerosing mesenteritis typically presents in the fifth or sixth decade of life, where patients with a history of abdominal surgery and/or autoimmune disease may be at higher risk. While many patients are asymptomatic, clinical features and complications are related to the mass effect resulting from the inflammation and fibrosis involved in the pathogenesis of SM. When present, common signs, symptoms, and complications include abdominal pain, weight loss, diarrhea, palpable abdominal mass on examination, bowel obstruction, chylous ascites, and mesenteric vessel thrombosis. Although SM was historically diagnosed predominantly by biopsy, current practice has shifted away from this to computed tomography imaging of the abdomen, given the invasive nature of biopsy. However, certain conditions, including mesenteric neoplasia (lymphoma, metastatic carcinoid tumor, desmoid tumor, mesenteric carcinomatosis), can mimic SM on imaging, and if clinical suspicion is equivocal, a biopsy may be warranted for definitive diagnosis. Asymptomatic patients do not require treatment. For patients with pronounced symptoms or complicated SM, the combination of tamoxifen 10 mg twice daily and prednisone 40 mg daily is the first-line pharmacotherapy; no randomized controlled trial of this regimen has been performed. Rarely, surgery may be necessary in cases of persistent bowel obstruction refractory to medical management. Sclerosing mesenteritis has an overall benign course in most cases, but disease progression and fatal outcomes have been reported.

Diagnostic Dilemma: IgG4-Related Sclerosing Mesenteritis Mimicking an Abdominal Malignancy Enveloping the Superior Mesenteric Artery

Sclerosing mesenteritis, a rare fibroinflammatory disease affecting the mesentery, presents a diagnostic challenge due to its varied clinical manifestations and unknown etiology. We present a case of a 50-year-old female presenting with epigastric pain and weight loss, initially suspected of abdominal malignancy. Imaging revealed a mesenteric mass, and histopathological examination confirmed dense lymphoplasmacytic infiltrate with storiform fibrosis, along with elevated serum IgG4 levels, indicative of IgG4-related sclerosing mesenteritis. Treatment with thalidomide and prednisolone resulted in significant mass regression and symptom improvement. Our case highlights the importance of considering sclerosing mesenteritis in the differential diagnosis of abdominal masses and suggests a potential therapeutic approach for this rare condition. Further research is warranted to elucidate its pathogenesis and optimize management strategies.

A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China

PURPOSE

Mesenteric panniculitis (MP) represents the uncommon, benign and chronic inflammatory disorder affecting the mesenteric adipose tissues. Its etiology, diagnosis and treatment remain unnoticed. Our report focused on shedding more lights on this condition.

PATIENTS AND METHODS

Seventeen MP patients were identified by searching the electronic medical record system in the Zhengzhou Ninth People's Hospital using the search terms "Mesenteric panniculitis" from October 2015 to March 2023. All cases were diagnosed with MP through computed tomography (CT). Their clinical features and treatments were analyzed.

RESULTS

There were altogether 17 cases enrolled for this analysis. The male to female ratio was 8:9, and the median age at diagnosis was 64 (range: 37-96) years. There were 15 patients (88.2%) showing abdominal pain to varying degrees. The proportions of symptoms of nausea, vomiting and fever were 23.5%, 23.5% and 41.2%, respectively. Neoplastic disease was present in 3 patients (17.6%). Meanwhile, 9 patients (52.9%) had gallstones, 3 (17.6%) had cholecystitis and 1 (5.9%) had gallbladder polyps. Six patients (35.3%) received antibiotics treatment only and 1 (5.9%) received oral antibiotics and prednisone. One patient (5.9%) received antibiotics followed by prednisone treatment, because the symptoms were significantly relieved after antibiotic treatment, while the disease recurred soon after, and the symptoms improved again after prednisone treatment. The abdominal pain in 9 patients (52.9%) was relieved spontaneously. Two patients (11.8%) died, including one due to respiratory failure caused by pneumonia and the other one because of pancreatic cancer with lung and liver metastases.

CONCLUSION

MP is a poorly understood chronic inflammatory disease. Patients often have abdominal pain as the main symptom, accompanied by comorbidities in the gallbladder, and the prognosis is usually good after correct diagnosis and treatment, Therefore, the present report aims to promote the awareness among clinicians of patients with non-classic abdominal symptoms, so as to avoid misdiagnosis or missed diagnosis.

Mesenteric panniculitis as a possible cause of fever of unknown origin

Mesenteric panniculitis is a non-neoplastic condition involving inflammation and fibrosis of the small bowel mesentery. We describe a man in his 60s who presented with 3 months of febrile episodes, confusion and weight loss. The diagnosis of mesenteric panniculitis had been established 2 weeks prior based on an abdominal computerized tomography scan. Extensive diagnostic investigations during his hospitalisation were unrevealing, and the symptoms were ultimately attributed to the mesenteric panniculitis. The fevers resolved over several weeks, and no further episodes have occurred since discharge. This case suggests that mesenteric panniculitis merits consideration in the differential diagnosis of fever of unknown origin.

Sclerosing mesenteritis following immune checkpoint inhibitor therapy

PURPOSE

Sclerosing mesenteritis (SM), a fibroinflammatory process of the mesentery, can rarely occur after immune checkpoint inhibitor (ICI) therapy; however, its clinical significance and optimal management are unclear. We aimed to assess the characteristics and disease course of patients who developed SM following ICI therapy at a single tertiary cancer center.

METHODS

We retrospectively identified 12 eligible adult cancer patients between 05/2011 and 05/2022. Patients' clinical data were evaluated and summarized.

RESULTS

The median patient age was 71.5 years. The most common cancer types were gastrointestinal, hematologic, and skin. Eight patients (67%) received anti-PD-1/L1 monotherapy, 2 (17%) received anti-CTLA-4 monotherapy, and 2 (17%) received combination therapy. SM occurred after a median duration of 8.6 months from the first ICI dose. Most patients (75%) were asymptomatic on diagnosis. Three patients (25%) reported abdominal pain, nausea, and fever and received inpatient care and corticosteroid treatment with symptom resolution. No patients experienced SM recurrence after the completion of corticosteroids. Seven patients (58%) experienced resolution of SM on imaging. Seven patients (58%) resumed ICI therapy after the diagnosis of SM.

CONCLUSIONS

SM represents an immune-related adverse event that may occur after initiation of ICI therapy. The clinical significance and optimal management of SM following ICI therapy remains uncertain. While most cases were asymptomatic and did not require active management or ICI termination, medical intervention was needed in select symptomatic cases. Further large-scale studies are needed to clarify the association of SM with ICI therapy.

Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report

Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.

Idiopathic sclerosing mesenteritis presenting with small bowel volvulus in a patient with antiphospholipid syndrome: A case report

BACKGROUND

Sclerosing mesenteritis is a rare disorder involving inflammation of the mesentery. Its etiology remains unclear, but it is believed to be associated with previous abdominal surgery, trauma, autoimmune disorders, infection, or malignancy. Clinical manifestations of sclerosing mesenteritis are varied and include chronic abdominal pain, bloating, diarrhea, weight loss, formation of an intra-abdominal mass, bowel obstruction, and chylous ascites. Here, we present a case of idiopathic sclerosing mesenteritis with small bowel volvulus in a patient with antiphospholipid syndrome.

CASE SUMMARY

A 68-year-old female presented with recurrent small bowel obstruction. Imaging and pathological findings were consistent with sclerosing mesenteritis causing mesenteric and small bowel volvulus. Computed tomography scans also revealed pulmonary embolism, and the patient was started on a high dose of corticosteroid and a therapeutic dose of anticoagulants. The patient subsequently improved clinically and was discharged. The patient was also diagnosed with antiphospholipid syndrome after a hematological workup.

CONCLUSION

Sclerosing mesenteritis is a rare condition, and patients with no clear etiology should be considered for treatment with immunosuppressive therapy.

Conservative Management of Mesenteric Panniculitis in a Remote Island

INTRODUCTION

Mesenteric panniculitis (MP) includes a spectrum of nonspecific fibroinflammatory disorders of unknown aetiology that affects mainly the root of the mesentery. Case Report. A 68-year-old man is incidentally diagnosed with MP during follow-up investigation for a fusiform coeliac artery aneurysm. Four years since the diagnosis, he is completely asymptomatic. After discussing with him and presenting the current evidence, he decided not to proceed with biopsy because the finding was incidental and he is asymptomatic. Moreover, tumour markers were within the normal range. He has been scheduled for annual follow-ups with computerized tomography (CT) scans and tumour markers.

CONCLUSIONS

MP is a rare chronic fibroinflammatory disease with contradictory evidence regarding its definition and management. Watchful follow-ups with CT scan and tumour markers are recommended for asymptomatic patients.

Anatomic and Functional Imaging of Immunoglobulin G4-related Disease and Its Mimics

Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated fibrosclerosing disease with tumefactive lesions infiltrated by IgG4-positive plasma cells. Initially described as autoimmune pancreatitis, IgG4-RD is now recognized as a discrete entity and is found to affect virtually any organ in the body. Common extrapancreatic sites include the biliary tree, salivary glands, periorbital tissue, lungs, kidneys, lymph nodes, aorta, retroperitoneum, and thyroid gland. Diagnosis-which relies on histopathologic, serologic, and radiologic features-can be challenging with the disease underdiagnosed, as IgG4-RD often mimics malignancy, infectious processes, or other immune-mediated conditions. Patients may present with signs of compression of nearby structures due to mass effect or with organ failure when the disease is left untreated. The clinical course is complex, with single- or multiorgan involvement and metachronous or synchronous occurrence of lesions. IgG4-RD responds well to glucocorticoid therapy, disease-modifying antirheumatic drugs, and B-cell-depleting biologic agents; prompt diagnosis is important to avoid delay in treatment and unnecessary pharmacologic or surgical intervention. While imaging features may not be specific for IgG4-RD, functional whole-body imaging with fluorine 18-fluorodeoxyglucose PET/CT is a useful adjunct for localizing extrapancreatic sites for biopsy, monitoring therapeutic response, and demonstrating disease relapse. The authors describe the pancreatic and extrapancreatic sites of involvement in IgG4-RD, with imaging features and patterns to aid in distinguishing IgG4-RD from its mimics through a multimodality approach with emphasis on functional imaging evaluation. ^©RSNA, 2023 Quiz questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Mesenteric panniculitis: a clinical conundrum

Mesenteric panniculitis is encountered frequently during abdominopelvic CT scanning, often as an incidental finding. The observation is problematic because an association with malignancy has been raised in the literature. This review will describe the CT appearances and examine the available evidence regarding the significance of this finding.Ultimately, the literature remains unclear regarding how these patients should be managed, if at all.

Successful treatment of sclerosing mesenteritis with tamoxifen monotherapy

Sclerosing mesenteritis is a rare disorder characterized by fat necrosis, chronic inflammation, and fibrosis of the small bowel mesentery. With a paucity of published clinical trials on sclerosing mesenteritis, treatment is based on case reports and trials of other fibrosing diseases, such as idiopathic retroperitoneal fibrosis. We present a case of a 68-year-old woman with sclerosing mesenteritis who exhibited complete symptomatic and radiographic resolution with the use of tamoxifen monotherapy.

Mesenteric panniculitis is associated with cardiovascular risk-factors: A case-control study

BACKGROUND

This study evaluated the prevalence of cardiovascular risk-factors in patients with mesenteric panniculitis.

AIMS

To determine whether cardiovascular risk-factors and mesenteric panniculitis are associated.

METHODS

Retrospective, matched case-control study of patients referred to Meir Medical Center, Israel, 2014-2019, who underwent computerized tomography scan, were diagnosed mesenteric panniculitis by radiologic criteria. They were compared to two, matched case-control groups: hospitalized patients without mesenteric panniculitis and the general population based on Israeli Ministry of Health surveys. Patients with active malignancy, IBD or significant intra-abdominal morbidity were excluded.

RESULTS

Of 376 patients with mesenteric panniculitis diagnosed by computerized tomography, 187 were included. Compared to hospital patients, they had higher incidence of dyslipidemia (77.5%/56.7%), hypertension (52.4%/40.6%), obesity (body mass index>30) (60.4%/30.5%) and nonalcoholic fatty liver disease (42.2%/16.6%). Similar differences were observed compared to the general population. In multivariable logistic regression, dyslipidemia, obesity, and nonalcoholic fatty liver disease were independent predictors for mesenteric panniculitis.

CONCLUSIONS

Patients with mesenteric panniculitis have more cardiovascular risk-factors compared to a case-control group and to the general population. This suggests that mesenteric panniculitis is clinically significant and may be part of the metabolic morbidity burden. This association should be further explored.

An Unusual Cause of Acute Abdominal Pain in Coronavirus Disease (COVID-19): Report of Two Cases

Coronavirus disease-2019 (COVID-19) is an infectious disease caused by coronavirus/2019-nCoV. It primarily manifests as lung infection, with fever and respiratory tract symptoms. Extrapulmonary complications affecting multiple organs are commonly seen, especially in critically ill patients. The reported gastrointestinal (GI) complications include transaminitis, acute pancreatitis, mesenteric ischemia, GI bleed, and ileus. Here, we report two cases of acute abdominal pain in patients with COVID-19 in their second week of illness. One patient had mild COVID-19 disease and the other had severe disease. Both patients had diffuse abdominal tenderness and raised inflammatory markers. The diagnosis of mesenteric panniculitis (MP) was made radiologically, and demonstrated with the presence of increased density of the mesentery with fat stranding (misty mesentery). Glucocorticoid administration resulted in the complete resolution of pain. They remained pain-free at 3 months of follow-up.

Sclerosing Mesenteritis: A Rare Cause of Abdominal Pain

Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea. SM occurs predominantly in Caucasian men, during the fifth to seventh decades of life. We present a 69-year-old woman with SM whose symptoms were thought to be from irritable bowel syndrome.

A 69-year-old female with a history of fibromyalgia presented with recurrent bouts of abdominal pain across her mid-abdomen lasting 30 minutes to an hour associated with nausea, alternating constipation and diarrhea with occasional mucus, and bloating. She used bismuth subsalicylate and ondansetron with temporary relief. Upper endoscopy and colonoscopy were unrevealing. Initially, she was felt to have irritable bowel. Later she presented with nausea and right upper quadrant pain and underwent cholecystectomy. When her pain recurred, the patient had a CT abdomen and pelvis which showed multiple sub-centimeter mesenteric lymph nodes with surrounding haziness and stranding in the root of the mesentery consistent with SM. The patient had a pannus biopsy showing fat necrosis that confirmed the diagnosis. She continued to have waxing and waning symptoms over several years and in the interim was diagnosed with melanoma limited to the skin. The patient had a particularly severe episode of abdominal pain prompting a repeat CT scan with a subsequent biopsy of an enlarged left para-aortic lymph node that revealed lymphoma.

Our patient’s diagnosis of SM was delayed as her symptoms were mistaken for irritable bowel syndrome. Worsening symptoms should alert clinicians to an alternate diagnosis such as SM. There are characteristic radiographic findings on CT scans and biopsy of the lesions. SM’s association with neoplastic diseases such as lymphoma, melanoma, colorectal, and prostate cancer is controversial, however, practitioners should be aware of this possibility and consider biopsy for any suspicious lesions.

Mesenteric panniculitis various presentations and management: A single institute ten years, experience

Mesenteric Panniculitis (MP) is predominately a disease of the small bowel of unknown etiology. Characterized by Fibrosis and chronic inflammation of fatty tissue of the mesentery in the small bowel. It is commonly diagnosed based on computed tomography (CT scan) with IV contrast and biopsies in equivocal cases. We conducted a retrospective study from 2011 to 2020. We analyzed the medical records of 40 patients with Mesenteric Panniculitis. The most common presentation was vague abdominal symptoms. We successfully managed the patients medically with prednisone, azathioprine, colchicine, or a combination. Patients on prednisolone showed good responses clinically and radiologically during follow-up. One patient was operated on and didn't respond to medical therapy.

Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition

Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis. There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions. While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.

Colchicine as an Alternative First-Line Treatment of Sclerosing Mesenteritis: A Retrospective Study

BACKGROUND

Sclerosing mesenteritis is a rare condition characterized by chronic inflammation and fibrotic changes of the mesentery.

AIMS

To determine the long-term management and outcomes of patients with sclerosing mesenteritis.

METHODS

Patients with biopsy-proven sclerosing mesenteritis at the Mayo Clinic between January 2006 and December 2016 were identified. Clinical data were collected retrospectively.

RESULTS

One hundred and three patients were identified, median age 68.0 years (range 35.0-85.3). Most patients were symptomatic (87.4%) at presentation. Patients received no treatment (52.4%), medical therapy (42.7%) or surgery (4.9%) on initial diagnosis. The most common initial regimens were prednisone plus tamoxifen (41.9%), prednisone alone (23.3%), and prednisone plus colchicine (11.6%) with 55.6%, 57.2%, and 60% of patients improving, respectively, p = 0.85 for a difference in response rates. At least half of the patients responded to prednisone plus tamoxifen, prednisone plus colchicine, or prednisone alone at 6.0, 7.2, and 8.4 months, respectively. At a median follow-up of 45.6 months (95% CI 24.1-69.7), 65.4% of patients were receiving medical therapy. Of those receiving tamoxifen-based, steroid-based, or steroid-sparing regimens, 100%, 87.5%, and 77.8% had improved by their last follow-up appointment respectively, p = 0.15.

CONCLUSION

Prednisone plus colchicine has a similar efficacy to prednisone plus tamoxifen for the initial and long-term treatment of sclerosing mesenteritis. The majority of patients were initiated on medical therapy over the long term with most reporting symptomatic improvement within a year. Death from SM was rare.

Sclerosing Mesenteritis Complicated With Mesenteric Lymphoma Responsive to Ustekinumab

A 45-year-old man with a 10-year history of biopsy-proven, steroid-dependent sclerosing mesenteritis failed/was intolerant to tamoxifen, azathioprine, colchicine, cyclophosphamide, and methotrexate. He developed osteoporosis, diabetes, and bilateral cataracts. He responded to infliximab but was diagnosed with mesenteric large B-cell lymphoma 6 months after treatment initiation. He achieved remission from lymphoma after chemotherapy, but the sclerosing mesenteritis remained poorly controlled. He was treated with ustekinumab (520 mg intravenously followed by 90 mg subcutaneously every 8 weeks), leading to complete steroid-free remission. He remains symptom and cancer-free 24 months after starting ustekinumab.

Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis

BACKGROUND

Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP.

METHODS

MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated.

RESULTS

Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group.

CONCLUSION

This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.

IgG4-related diseases of the digestive tract

IgG4-related conditions affecting the digestive tract are part of a multi-organ fibro-inflammatory disorder termed IgG4-related disease (IgG4-RD), with autoimmune pancreatitis and IgG4-related cholangitis being the most prominent manifestations. Gastrointestinal symptoms include jaundice, weight loss, abdominal pain, biliary strictures, and pancreatic and hepatic masses that mimic malignant diseases. IgG4-RD manifestations occur less frequently elsewhere in the digestive tract, namely in the oesophagus, retroperitoneum or intestine. Evidence-based European guidelines frame the current state-of-the-art in the diagnosis and management of IgG4-related digestive tract disease. Diagnosis is based on histology (if available), imaging, serology, other organ involvement and response to therapy (HISORt criteria). Few biomarkers beyond serum IgG4 concentrations are reliable. The first-line therapy (glucocorticoids) is swiftly effective but disease flares are common at low doses or after tapering. Second-line therapy might consist of other immunosuppressive drugs such as thiopurines or rituximab. Further trials, for example, of anti-CD19 drugs, are ongoing. Although an association between IgG4-RD and the development of malignancies has been postulated, the true nature of this relationship remains uncertain at this time.

Peritoneal Cancer Mimicking Sclerosing Mesenteritis: A Case Report

Peritoneal cancer is a rare disease that typically affects middle-aged women. Sclerosing mesenteritis can have a benign or malignant etiology. Although computed tomography (CT) scan and magnetic resonance imaging have been used to differentiate these two diseases, the findings are not always conclusive. Here, we report the case of an older woman who presented with acute abdominal pain. She was initially diagnosed with sclerosing mesenteritis, but the final diagnosis was peritoneal cancer. The initial treatment included antibiotics, non-steroidal anti-inflammatory drugs, and prednisolone. Tamoxifen was administered due to persistent symptoms, which were alleviated. However, the patient’s cancer antigen 125 levels were elevated, and there were changes in the peritoneal CT findings. The patient was diagnosed with primary peritoneal cancer based on further investigation of the peritoneum using positron emission tomography-CT and a biopsy. This case report describes the diagnostic process regarding the differentiation between sclerosing mesenteritis and primary peritoneal cancer when the CT findings mimic those of sclerosing mesenteritis in general medicine.

Idiopathic Sclerosing Mesenteritis: An Extremely Rare Cause of Mesenteric Mass

Idiopathic sclerosing mesenteritis (ISM) is an extremely rare condition in which mesenteric adipose tissue undergoes necrotic and fibrotic changes. It is also known as "retractile mesenteritis", "mesenteric panniculitis" or "fat necrosis of the mesentery". Most cases are seen in Caucasian males between the fifth and seventh decades of life. Some of the suggested causes of this extremely rare condition include autoimmune disorders, abdominal trauma, malignancy, abdominal infections and even IgG4-related diseases; however, the actual cause remains unknown. Most cases are either self-limiting or improve with medical therapy. However, aggressive cases requiring emergent surgical interventions to relieve intestinal obstruction have been reported in the literature. We present a case of a 60-year-old male patient who presented to the emergency room with severe abdominal pain and was diagnosed with ISM that required surgical intervention to relieve the symptoms.

Nodular Sclerosing Mesenteritis: An Occasional Finding Mimicking a Spindle Cell Tumor

BACKGROUND The term "sclerosing mesenteritis" includes a spectrum of rare idiopathic diseases involving the small and/or large bowel. It appears as a diffuse, localized, or multinodular thickening of the mesentery, with a variable degree of chronic non-specific inflammation, fat necrosis, and fibrosis. CASE REPORT Here, we report a case of 83-year-old woman with symptoms of intestinal occlusion, vomiting, and abdominal pain. Radiographic examinations showed air fluid levels in right and left quadrants and in the mesogastric site, while computed tomography (CT) documented a strangulated inguinal hernia with ileal obstruction. Based on clinical examination and radiologic findings, the patient underwent surgery for inguinal hernia reduction. The examination of viscera revealed 2 tracts of ileum with ischemic signs and covered by fibrin; thus, the 2 intestinal loops were resected. Histological examination revealed chronic non-specific inflammation of the whole intestinal wall, including the subserosa in the resected tract of proximal ileum, while the distal ileal loop (not herniated tract) showed a subserosal fibrous nodule of 2 cm in greatest diameter, composed of a proliferation of spindle cells haphazardly arranged in a collagenized stroma. The diagnosis of sclerosing mesenteritis was rendered. CONCLUSIONS The present case shows the possibility of an incidental diagnosis during another intervention such as hernia surgery. Pathologists should be aware of this disease to avoid confusion with aggressive tumors such as intra-abdominal desmoid-type fibromatosis and gastrointestinal stromal tumor.

Colon Perforation As Initial Presentation of Refractory and Complicated Sclerosing Mesenteritis

Sclerosing mesenteritis (SM), a benign chronic fibrosing inflammatory disease of the mesentery, is a rare disease discovered in 1924. The prevalence of the disease is less than 1%. The exact etiology of the disease is not clear. It is thought that the integrity of the gastrointestinal lumen may be altered from chronic inflammatory effects. SM may be associated with autoimmune diseases, trauma, malignancy, or surgery. The most common clinical presentation is abdominal pain. Obstructive symptoms may occur. Diagnosis is made by CT abdomen and biopsy. Treatment includes surgical and immunosuppressive medications.

Sclerosing Mesenteritis, a Rare Cause of Mesenteric Mass in a Young Adult: A Case Report

Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine, with an insidious clinical presentation having symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss. We report a case of a 23-year-old male presenting with palpable abdominal mass, mesogastric pain, and a history of rapid weight loss, who underwent exploratory laparoscopy. A hemorrhagic and gelatinous nodular tumor mass of the mesentery was identified and the surgical procedure was converted to a laparotomic approach. Histologically, the mass was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells (lymphocytes, plasma-cells, and histiocytes) were also evident. The diagnosis of sclerosing mesenteritis was made. Our case emphasizes that histology remains pre-eminent for a correct diagnosis of SM, as pre-operative radiological-based diagnosis is non-specific.

[Motility disorder and weight loss in a 71-year-old male patient]

A 71-year-old man presented to this clinic for evaluation of an unclear abdominal tumor. He complained of abdominal pain, weight loss and motility disorders, which began some weeks previously. Ultrasound and computed tomography (CT) scans showed a large mesenterial space-occupying lesion with accompanying lymphadenopathy, slight accumulation of ascites and venous congestion. For confirmation of the suspected diagnosis of a sclerosing mesenteritis and exclusion of a lymphoma a laparoscopy was carried out with excision of tissue. The material was not adequately representative so that a laparotomy was carried out for removal of a new tissue specimen. The tissue specimen confirmed the rare diagnosis of sclerosing mesenteritis and due to the complaints a pharmaceutical treatment with prednisone and tamoxifen was initiated.

A case of immunoglobulin G4-related sclerosing mesenteritis without other organ involvement

A 64-year-old man presented to our hospital with abdominal pain and 4-5 episodes of watery diarrhea per day for 2 months. Abdominal ultrasound examination revealed a mass in the peritoneal cavity, and computed tomography showed a 13.4 cm mass in the mesentery and a 3 cm mass in the mesocolon. The patient underwent laparoscopic partial resection for diagnosis. Microscopically, abundant fibrosis and numerous immunoglobulin (Ig) G4-positive plasma cells were observed. The serum level of IgG4 was 665 mg/dl postoperatively. These findings suggested that the lesion was consistent with IgG4-related sclerosing mesenteritis. Oral steroids resulted in rapid disappearance of symptoms and a decrease in masses. Recently, sclerosing mesenteritis are reported as IgG4-related disease or mimicking IgG4-related disease but multiple lesions rarely occur in the same organ. We report a case of IgG4-related sclerosing mesenteritis with multiple lesions without involvement of other organs, such as the pancreas and salivary glands.

Peritoneal or mesenteric tumours revealing histiocytosis

Objective

Peritoneal or mesenteric tumours may correspond to several tumour types or tumour-like conditions, some of them being represented by histiocytosis. This rare condition often poses diagnostic difficulties that can lead to important time delay in targeted therapies. Our aim was to describe main features of histiocytoses with mesenteric localisation that can improve the diagnostic process.

Design

We performed a retrospective study on 22 patients, whose peritoneal/mesenteric biopsies were infiltrated by histiocytes.

Results

Abdominal pain was the revealing symptom in 10 cases, and 19 patients underwent surgical biopsies. The diagnosis of histiocytosis was proposed by initial pathologists in 41% of patients. The other initial diagnoses were inflammation (n=7), sclerosing mesenteritis (n=4) and liposarcoma (n=1). The CD163/CD68+CD1a- histiocytes infiltrated subserosa and/or deeper adipose tissues in 16 and 14 cases, respectively. A BRAF^V600E mutation was detected within the biopsies in 11 cases, and two others were MAP2K1 mutated. The final diagnosis was histiocytosis in 18 patients, 15 of whom had Erdheim-Chester disease. The median diagnostic delay of histiocytosis was 9 months. Patients treated with BRAF or MEK inhibitors showed a partial response or a stable disease. One patient died soon after surgery, and five died by the progression of the disease.

Conclusion

Diagnosis of masses arising in the mesentery should be carefully explored as one of the possibilities in histiocytosis. This diagnosis is frequently missed on mesenteric biopsies. Molecular biology for detecting the mutations in BRAF or in genes of the MAP kinase pathway is a critical diagnostic tool.

Association between mesenteric panniculitis and non-neoplastic disorders

PURPOSE

To assess the relationship between MP and coexisting non-neoplastic disorders.

METHODS

Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann-Whitney U, χ², or Fisher's test.

RESULTS

976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064-0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012-0.036).

CONCLUSION

MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.

A 67-Year-Old Woman With Abdominal Pain and Dyspnea

CASE PRESENTATION

A 67-year-old woman presented to her primary physician with a year of periumbilical abdominal discomfort with diarrhea, bloating, and unintentional weight loss. While undergoing workup for the abdominal pain, she presented to the ED with dyspnea that worsened over a few weeks. She had no associated chest pain, lower extremity edema, fevers, or chills, but endorsed orthopnea. The patient's medical history included hypothyroidism and diabetes mellitus. Her family history was significant for coronary disease in her father and hypertension in her mother. She had no recent travel; she is a nonsmoker and rare alcohol drinker. She worked in administration.

Immunoglobulin G4-related systemic disease: mesenteric and peritoneal involvement with radiopathological correlation and differential diagnoses

Since its first introduction in 2003 by Kamisawa et al., IgG4-related disease has gained wide interest in the imaging community, and several manuscripts have been published regarding its imaging features. In addition to initial observations in the pancreaticobiliary system, it is now well known that the disease may involve every organ system in the body. There is not much information in the imaging literature about the involvement of mesentery, omentum, and peritoneum in this disease. This article aims to provide more information about the imaging findings of IgG4-related disease regarding these areas by making radiopathological correlations and discussing the possible differential diagnoses.

Magnetic Resonance Imaging, the Virtual Biopsy of Mesenteric Masses

ABSTRACT

The mesentery may be affected by multiple disease processes. Magnetic resonance imaging aids as a virtual pathological biopsy tool in the assessment of mesenteric masses because of superior soft tissue contrast and characterization. In this comprehensive review, we describe in detail the magnetic resonance imaging features of some solid and cystic mesenteric masses, with an emphasis on lesion-specific signal characteristics on T1- and T2-weighted images, diffusion-weighted imaging, and enhancement features on the dynamic postcontrast phase that aid in narrowing the differential diagnosis.

Ultrasonography-Based Management of Sclerosing Mesenteritis: From Diagnosis to Follow-Up

Sclerosing mesenteritis (SM) is an idiopathic disorder affecting mesentery, characterized by fat necrosis, chronic inflammation and fibrosis. The clinical presentation varies from asymptomatic cases to acute abdomen. The diagnosis is suggested by imaging but can be definitely established only by biopsies. In this paper, we discuss ultrasonography-based management of SM.

Mesenteritis esclerosante: diagnóstico y tratamiento

Introducción. El objetivo de este artículo es dar a conocer el caso de un paciente con diagnóstico de mesenteritis esclerosante quien cursó con cuadro de obstrucción intestinal. Descripción del caso. Paciente masculino de 28 años de edad, quien se presenta con cuadro clínico sugestivo de obstrucción intestinal, por lo que se decide resolución quirúrgica. Durante la cirugía se observa una zona fibrótica y adherente del intestino delgado, asociada a un mesenterio engrosado. El exámen histopatológico de la pieza quirúrgica confirmó el diagnóstico de mesenteritis esclerosante. Discusión. La mesenteritis esclerosante es una patología de baja incidencia, y su forma de presentación es inespecífica, por lo que el diagnóstico definitivo es histopatológico. La tomografía es útil para el diagnóstico cuando se tiene la sospecha clínica. Puede optarse por el tratamiento quirúrgico para los casos que se presenten con clínica de obstrucción intestinal, o en caso contrario, el tratamiento médico a base de fármacos inmunosupresores e inmunomoduladores ha demostrado ser efectivo. De acuerdo con los diferentes estudios publicados hasta el momento, se observa una adecuada respuesta, independientemente del tratamiento empleado.

Debilitating Manifestation of a Disease with Multiple Names: A Severe Case of Sclerosing Mesenteritis

Sclerosing mesenteritis (SM) is a rare inflammatory condition with unknown etiology that affects the mesenteric adipose tissue. We present a case of a 49-year-old male with severe abdominal pain who underwent abdominal biopsy confirming the presence of adipose inflammation and necrosis. The diagnosis of SM was made, and the patient was treated with prednisone and tamoxifen. As this condition is rare, there are no standard guidelines for management. This case aims to outline a possible treatment plan.

Surgical Excision of Sclerosing Mesenteritis, Exploration of an Unknown Mesenteric Mass

Sclerosing mesenteritis is a rare and often benign condition characterized as a fibrotic disease consisting of non-suppurative inflammation of adipose tissue. Through mass effect, sclerosing mesenteritis can compromise the gastrointestinal lumen as well as mesenteric vessel integrity. There is a poor understanding of this disorder and its pathogenesis, which presents with various symptomatology and often without identification of inciting factors. Patients with sclerosing mesenteritis exhibit gastrointestinal and systemic manifestations including weight loss, fever, nausea, vomiting, diarrhea, and abdominal pain. This case presents a patient with a seven-month history of chronic, epigastric abdominal pain following laparoscopic surgery for acute uncomplicated appendicitis. The patient underwent work-up with computed tomography and magnetic resonance enterography that confirmed the presence of a mesenteric mass of unknown etiology located in the mid-epigastrium. Due to the inability to safely sample the mass, the patient underwent diagnostic laparoscopy, which was subsequently converted to an open procedure where excision of the mesenteric lesion was performed. Surgical pathology revealed fat necrosis with fibrosis, granulomatous inflammation, and dystrophic calcifications consistent with sclerosing mesenteritis. The patient was seen in follow-up with the resolution of her epigastric abdominal pain. This case report demonstrates a unique presentation of a symptomatic patient with a mesenteric mass not amenable to non-invasive biopsy. Complete excision of this lesser sac mass revealed sclerosis mesenteritis as the pathological cause.