Retractile mesenteritis of the sigmoid colon

Sclerosing mesenteritis presenting with small bowel obstruction and subsequent retroperitoneal fibrosis

Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery of unknown aetiology. It poses a diagnostic challenge for clinicians, as it can be mistaken for malignancy. We report a case of sclerosing mesenteritis initially presented with abdominal pain, tender abdominal mass and small bowel obstruction. Emergency laparotomy revealed fibrous thickening of the small bowel mesentery mimicking small bowel lymphoma. An ileo-ileal bypass procedure was performed. Six months later, the patient developed retroperitoneal fibrosis, manifesting as bilateral obstructive uropathy. Our case is unique, as it describes retroperitoneal fibrosis developing in a patient with small bowel retractile mesenteritis, with no evidence of colonic or other anatomical involvement. Furthermore, the patient had no risk factors for this condition. We conclude that the presence of sclerosing mesenteritis should cue clinicians to search for other coexisting inflammatory disorders that can have serious sequelae.

Mesenteric panniculitis versus pancreatitis: a computed tomography diagnostic dilemma

A case of mesenteric panniculitis is described in a patient with CT features mimicking pancreatitis. Emphasis is on the important CT features for accurate diagnosis.

Mesenteric panniculitis associated with abdominal tuberculous lymphadenitis: a case report and review of the literature

Mesenteric panniculitis is a rare disease characterized by chronic non-specific inflammation of the mesenteric adipose tissue. The specific aetiology of the disease is previously unknown. A case diagnosed as mesenteric panniculitis is presented. The cause was biopsy-proved abdominal tuberculous lymphadenitis. To our knowledge, mesenteric panniculitis associated with tuberculosis infection has not been reported previously in the literature. Thus, we would like to present the first case and describe CT features of the disease.

Mesenteric panniculitis of the colon with obstruction of the inferior mesenteric vein: report of a case

Mesenteric panniculitis is a rare disease characterized by nonspecific inflammation of the fat tissue of the mesentery. We present an extremely rare case of mesenteric panniculitis of the sigmoid colon, complicated by occlusion of the inferior mesenteric vein. A 75-year-old male presented with a one-month history of abdominal distention and abdominal mass without pain. Physical examination revealed a firm mass in the lower abdomen. Barium enema study demonstrated rugged mucosa and a serrated contour in the rectosigmoid colon. Computed tomography showed that the mass arose from the mesentery, which surrounded the mesenteric vessels. The density of the mass was slightly higher than that of fatty tissue. Based on these radiologic findings, the patient was diagnosed as having mesenteric panniculitis of the rectosigmoid colon. Colonoscopy showed narrowing with edematous mucosa in the rectosigmoid colon, whereas marked dilated vessels were noted in the proximal portion of the sigmoid colon. Angiography showed occlusion of the inferior mesenteric vein, with venous flow returning via a collateral vein. The patient was observed without medication because his condition was satisfactory. His symptoms subsequently disappeared during a period of several weeks. The mass in the lower abdomen gradually diminished in size, disappearing three months later. Computed tomography and barium enema showed improvement of the lesion. The favorable outcome of the present case was probably because of formation of a collateral vein. The present case suggests that aggressive therapy for mesenteric panniculitis should be avoided, because the outcome of this disorder is good, even when there is obstruction of vessels.

Retractile mesenteritis of the large bowel: report of a case and review of the literature

We report herein the case of a 46-year-old woman found to have retractile mesenteritis of the rectosigmoid colon. A review of 52 cases of retractile mesenteritis of the large bowel collected from the literature is discussed following our case report. The average age of the patients was 54.5 years and the male: female ratio was 37:15. The majority of lesions (61.5%) were located in the rectosigmoid colon, with abdominal pain, an abdominal mass, constipation, and fever being the most common symptoms. The diagnosis was only able to be made at the time of laparotomy in 90.4% of the patients. The gross appearance at surgery was characterized by a thickened, shortened, and retractile mesentery, forming nodular masses involving the appendices epiploicae of the colon. Microscopically, fibrosis, inflammatory cell infiltrations, degeneration of the fatty tissue or fat necrosis, and aggregations of lipid-laden foamy cells were observed in most patients. The mass involving the colon was resected in 59.6% of the patients, but even external or bypass colostomy demonstrated favorable results.

Advanced gastrointestinal malignancy or benign inflammatory disease? An unusual presentation of sclerosing mesenteritis. Report of a case

The presentation of change of bowel habit, weight loss, muscle wasting, ascites, and the surgical appearance of "omental cake" are almost pathognomonic of advanced gastrointestinal malignancy. In our case, these symptoms represented a unique presentation of the condition sclerosing mesenteritis. Despite its rarity, the clinician should be aware of this "sheep in wolf's clothing," the clinical importance of which lies in the condition's benign and self-limiting course and imparts to the patient a prognosis and treatment that could not be further removed from that of advanced malignancy. Investigations that may be helpful to the surgeon in distinguishing the condition from carcinomatosis and avoiding unnecessary laparotomy include preoperative colonoscopy, barium enema, cytology of any ascites, and intraoperative frozen section biopsy. Treatment of the condition is conservative unless it has caused extrinsic bowel obstruction.

Mesenteric panniculitis resulting in bowel obstruction: response to steroids

Two patients with mesenteric panniculitis are presented. The first developed obstruction of the sigmoid colon requiring a decompressing proximal sigmoid end-colostomy; the second presented with an incomplete small bowel obstruction. A convincing, immediate, symptomatic response to steroids was noted in both patients. The first patients responded to such an extent that closure of the colostomy was possible some 10 months later. It would appear that active subacute mesenteric panniculitis, as evidenced by continuing fever, high erythrocyte sedimentation rate and predominance of inflammatory cells with only minimal fibrosis on histologic section, is likely to respond favourably to steroid treatment. Review of the surgical literature indicates that, once the condition has progressed to established fibrosis, steroid treatment is probably ineffectual.

Mesenteric panniculitis of the colon. Review of the literature and report of two cases

Eighteen cases of mesenteric panniculitis of the colon collected from the literature, together with two cases from the authors' source, were reviewed. The disease occurred most often in late adult life, with a male predominance. Symptoms were abdominal pain, diarrhea, constipation, and a lower abdominal mass in most patients. Barium enema disclosed narrowing, shortening, and poor extensibility of the colon, and ultrasonography and computed tomography showed thickening of the mesocolon and colonic wall with soft-tissue density. Exploratory laparotomy was done in all patients, and colectomy, colostomy, or other surgical treatments were performed in 17 (85 percent). Gross appearance at the time of surgery was characterized by a marked thickening or a firm mass of the mesocolon with a puckered surface involving the appendices epiploicae of the colon. Microscopically, degeneration of the adipose tissue, revealed by aggregates of lipid-laden macrophages, was diagnostic. Inflammatory infiltration and fibrosis also were present in many patients. Mesenteric panniculitis of the colon seems to be a lesion more advanced than the same condition of the small intestine, and colostomy or bypass surgery may be needed for alleviation of severe symptoms.