Successful treatment of retractile mesenteritis with oral progesterone

Retractile mesenteritis is a rare inflammatory mesenteric disorder that involves the intestine secondarily. The natural history of this process is diverse, but most patients require some empiric therapeutic measures. Up to now, pharmacological therapy has included corticosteroids, colchicine, and immunosuppressive drugs. Although these drugs are successful in most patients, some have been refractory to these therapies and, in others, the beneficial effects were counterbalanced by adverse reactions. Many patients require surgery, but most have poor results. This report describes a 42-year-old man with histologically proven retractile mesenteritis refractory to surgical intervention who had a good response to oral progesterone (10 mg/day for 6 months) with complete disappearance of tumor mass and clinical symptoms. No adverse effects were detected. Current knowledge about the mechanism by which progesterone affects fibrogenesis is scanty. It seems likely that progesterone down-regulates proliferation and metabolism of fibroblasts and fibrogenesis.

Mesenteric panniculitis

Mesenteric panniculitis is a non-neoplastic inflammatory process affecting the adipose tissue of the mesentery. It is an extremely rare disease. We report the case of a 30-year-old man with mesenteric panniculitis and describe the radiologic findings.

Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity?

We reviewed 84 cases coded as mesenteric lipodystrophy (ML), mesenteric panniculitis (MP), or retractile mesenteritis and sclerosing mesenteritis (SM), grading fibrosis, inflammation, and fat necrosis, and evaluating clinical subgroups. There was no gender or racial predominance. Patient age range was 23-87 years (average 60). Patients most often presented with abdominal pain or a palpable mass. A history of trauma or surgery was present in four of 84 patients. The most common site of involvement was the small bowel mesentery as a single mass (58 of 84) with an average size of 10 cm, multiple masses (15 of 84), or diffuse mesenteric thickening (11 of 84). All patients had some degree of fibrosis, chronic inflammation, and fat necrosis. Although a few patients showed a sufficient prominence of fibrosis, inflammation, or fat necrosis to permit a separation into SM, MP, or ML, respectively, in most patients these three components were too mixed for a clear separation. The clinical, demographic, and gross features did not help in defining these three entities. Contributors diagnosed 12 as sarcoma. Of 39 patients followed beyond the postoperative period, none died of these lesions. We conclude that SM, MP, and ML appear to represent histologic variants of one clinical entity, and in most cases "sclerosing mesenteritis" is the most appropriate diagnostic term.

[Mesenteric panniculitis in the differential diagnosis of abdominal pain]

Mesenteric panniculitis is a rare disease affecting adipose tissue of the mesentery that may result in the development of large masses in the abdomen. Diffuse chronic or intermittent abdominal pain is the most frequent symptom. It usually follows a benign course though surgery is sometime needed. We describe a patient with recurrent abdominal pain who was diagnosed of mesenteric panniculitis. An abdominal CT scan oriented to the diagnosis and an open laparotomy and biopsy was needed for a definitive diagnosis. A brief review of the literature is added.

[Mesenteric panniculitis]

We report three cases of mesenteric panniculitis in which the disease took different courses. The first case clinically mimicked an acute diverticulitis and consequently laparotomy was performed. During this operation a large space-occupying tumour was found in the lower abdomen. After resecting this tumour mass of uncertain classification (benign or malignant) a preternatural anus of sigmoid colon was formed. Histological exploration revealed mesenteric panniculitis. Six months later we restored continuity of large bowel by end-to-end anastomosis. No residues of the preexisting panniculitic alterations were seen. The second case concerned a female patient who again complained of discomfort after surgical treatment of colon carcinoma. We measured an elevated erythrocyte sedimentation rate and suspected a relapse of the malignant disease. Notwithstanding radiological and endoscopic diagnostics, the origin and classification of an intra-abdominal tumour could not be determined preoperatively. Laparoscopically we took a biopsy of the local mass, but a definite diagnosis was not found. Postoperatively undulant fever occurred, uninfluenced by cortisone treatment. Finally the patient died because of unstoppable hemorrhage under coagulopathy. Mesenteric panniculitis was identified as causative disease by autopsy.

[Severe weight loss at the beginning of mesenteric panniculitis]

We report a case of mesenteric panniculitis that presented with a severe lost of weight. We stress the difficulty that entails the diagnosis of this unusual entity, and also the excellent response to corticoid therapy in our patient. The clinical, pathological and therapeutic features of mesenteric panniculitis are reviewed.

[A case of chylothorax caused by mesenteric panniculitis]

A 76-year-old female was referred to our hospital for examination of milky pleural effusion. We diagnosed her illness as chylothorax because of the high concentration of triglyceride in the effusion. There was neither obstruction nor damage of the thoracic duct. Systemic evaluation disclosed an abdominal mass in the umbilical region. Fasting with intravenous hyperalimentation followed by pleurodesis with minocycline successfully eliminated the effusion. On the other hand, the abdominal mass was diagnosed as mesenteric panniculitis by open biopsy. Since she also had chylous ascites, the tumor could have obstructed the intestinal lymphatics. Chylothorax was probably caused by damage to collateral lymph circulation.

Concomitant sclerosing mesenteritis and inflammatory pseudotumor simulating gastric lymphoma or linitis plastica

Both inflammatory pseudotumors and sclerosing (retractile) mesenteritis are uncommon conditions of unknown origin. A number of authors have reported patients presenting with complaints that were attributed to one or the other of these entities. In our review of the literature, we were unable to find a single case report of mixed abdominal findings that could be explained by the presence of both conditions. We report a case of the patient presenting with abdominal mass that was identified as having features of both sclerosing mesenteritis and inflammatory pseudotumor on pathologic diagnosis.

Mesenteritis secondary to the use of a pneumatic jackhammer

Mesenteritis is an uncommon condition characterized by a variable clinical course, in which spontaneous remission may occur, but in which uncontrollable disease activity leads to death [corrected]. We describe a construction worker with mesenteritis who presented with vague abdominal discomfort and mucoid diarrhoea. A large, irregular mass was found in the abdomen. Upon explorative laparotomy, a large, rubbery, grey and yellow, irresectable tumorous mass was found, which apparently originated from the mesentery of the small bowel. The large bowel was expanded over the tumorous mass. A defunctioning colostomy was made. Histologic examination of biopsy specimens revealed only fatty necrosis of the mesentery and no evidence of malignancy. It is assumed that a pseudotumour of the mesentery had developed after chronic repetitive abdominal trauma caused by the continuous vibration of a pneumatic jackhammer, on which the patient pressed his abdomen during construction work. In this case of mesenteritis, the clinical course was one of spontaneous and complete recovery.

Protein-losing enteropathy: first manifestation of sclerosing mesenteritis

OBJECTIVE

To report the case of an unusual form of protein-losing enteropathy.

PATIENT

A 54-year-old patient with hypoechoic tumours resembling lipomas in the mesentery.

INTERVENTIONS

Following examination by ultrasound and computed tomography, the well-known intestinal and extra-intestinal forms of protein-losing enteropathy were excluded and a diagnostic laparotomy was performed. The whole mesentery was infiltrated by a large unresectable tumour. Histological examination showed that it was a sclerosing mesenteritis.

MAIN OUTCOME MEASURES

Steroid therapy dramatically improved the protein-losing enteropathy.

CONCLUSION

Pathogenically, the enteropathy may be interpreted as the result of disturbed lymphatic drainage caused by the sclerosed mesentery.

[Retractile mesenteritis. Report of 3 cases]

Mesenteric panniculitis is an infrequent pathology; the diagnosis is made by the pathologist and it is characterized by inflammation, fibrosis and retraction of the mesenteric fat. We report three new cases of retractile mesenteritis or mesenteric panniculitis, two cases presented with intestinal obstruction and the other had an abdominal tumour. In all cases the pathological diagnosis was retractile mesenteritis.

[Panniculitis mesenterialis, a rare disease]

Panniculitis mesenterialis is an illness of the mesenterium of the small intestine and is not familiar to all clinical physicians. The rare reports in the literature mostly describe a good outcome with a few cases ending lethal. Pathologists paying attention to detect panniculitis during postmortem examination report about an incidence of about 1%. This discrepancy may be based on the fact that only extended changes of the mesenterial fat tissue cause symptoms. The pathological base consists in extensive necrosis of fat tissue with fibrosis of the mesenterium. Aetiology is unknown, diagnosis is usually made during laparotomy. There is no specific treatment, prognosis is generally good.

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.

[A case of mesenteric panniculitis: comparing the findings of 67Ga scintigraphy with pathological results]

We report a case of mesenteric panniculitis where we compared the findings of 67Ga-citrate (Ga) scintigraphy with pathological results. The patients, a 75-year-old man, was hospitalized for examination of low abdominal mass. After hospitalization he developed high CRP levels. A Ba enema revealed serrated intestinal walls and a thick fat density, the margins of which were distinct, as judged from abdominal CT scans. Therefore we suspected a mesenteric panniculitis. Since the patient did not improve under conservative treatment for three months, surgery was performed a day after Ga scintigraphy which showed the abnormal uptake in the abdominal mass, which was removed. The radioactivity of several tissue slices from the resected specimen containing the affected part which had been described inflammatory in the pathological examination showed very high radioactivity. This disease is usually diagnosed from the typical findings of Ba enema and CT scan. But, when an extraordinary abdominal accumulation presents, one should think of performing a Ga scan as an additional diagnostic parameter.

Mesenteric panniculitis: report of two cases

Mesenteric panniculitis is a rare inflammatory process of the mesenteric fat with unknown etiology. We report two pathologically proven cases of mesenteric panniculitis. Both patients presented with abdominal pain and palpable masses. In one patient, computed tomography (CT) demonstrated a well-defined heterogenous mass containing fat density at the mesocolon. In the other patient, CT showed a fatty mass encompassing mesenteric vessels at the root of the mesentery. Although the definite diagnosis of mesenteric panniculitis depends on histopathology, recognition of CT features is helpful in the diagnosis and avoids unnecessary extensive operation.

[Mesenteric panniculitis]

A 70-year-old patient with a 6 x 6 x 12 cm mass involving the mesentery root is discussed. The pseudotumorous infiltration was detected by ultrasound done because of nonspecific abdominal symptoms and weight loss. Laparoscopic biopsy confirmed the diagnosis of mesenteric panniculitis. The primary histologic criterion is infiltration of the mesenterium by foamy lipid-laden macrophages, clusters of lymphocytes and fibrosis. The majority of cases follow a benign course and need no therapy, but co-existence of lymphoma has been reported. There have been few cases where panniculitis with progressive fibrosis changed into retractile mesenteritis with shortening of the mesenterium and compression of mesenteric vessels with partial or complete intestinal obstruction or ischemia requiring surgery. Few reported cases of severe and progressive disease have been treated with prednisone and azathioprine or cyclophosphamide.

Mesenteric panniculitis presenting as a multilocular cystic mesenteric mass: CT and MR evaluation

Mesenteric panniculitis is a non-neoplastic, inflammatory process affecting the adipose tissue of the mesentery in adults with slight male predilection. Typical computed tomography (CT) or magnetic resonance imaging (MRI) findings are of either diffuse mesenteric infiltration or nodular mesenteric masses. We encountered a case of mesenteric panniculitis in a 26-year-old woman with the left upper quadrant pain and fullness, in which CT and MRI disclosed a large, ill-defined, multilocular cystic mesenteric mass. After surgery, the diagnosis of mesenteric panniculitis was made. The cystic components were dilated lymphatics due to lymphatic and venous obstruction by the mesenteric panniculitis.

[Mesenteric panniculitis]

In a 76 year old patient computed tomography of the abdomen and laparoscopic biopsy revealed a mesenteric panniculitis as cause of recurrent fever and shaking chills. The fever resolved under corticosteroid therapy and the patient remains well three month after onset of treatment.

[Mesenteric panniculitis. Apropos a case and a review of the literature]

The case of a 35 year old female who had paraneoplasic syndrome during a period of one year, together with abdominal pain, is presented. Owing to the aforementioned, she was operated under the suspicion of lymphoma. The intraoperatory diagnosis was of retroperitoneal fibrosis. Physical examination showed important ascites and cachexia. Mild anemia and high sedimentation rate were found in blood test. A barium intestinal X-ray showed loop distention and a CT scan showed ascites and mesenteric thickening which were confirmed by a laparotomy. The histological study showed substantial cholagen and inflammatory infiltrate, together with giant cells of foreign body type. The different clinical presentations were reviewed as well as diagnoses, treatments, and the evolution of the disease.

[Mesenteric panniculitis of the sigmoid. A case report and review of the literature]

Mesenteric panniculitis is an extremely rare disease in which the normal fatty architecture of the mesentery is replaced by fibrosis, necrosis and calcification. One hundred twenty-four cases of mesenteric panniculitis have been described in the literature; only five of these involved the sigmoid mesentery. The following case report is of mesenteric panniculitis confined to the sigmoid colon. Symptomatology, pathology, treatment and outcome of this disorder are discussed. It seems that this disease is a well established clinical entity of unknown etiology with a benign course and favorable outcome. Radical surgical treatment is not advised. If mesenteric panniculitis is encountered at operation, biopsy to establish the diagnosis is indicated. If the mechanical effects are significant, they should be corrected.

Mesenteric panniculitis

We have reviewed the case of a young man with an omental mass diagnosed as mesenteric panniculitis. The clinical history, physical findings, and laboratory and radiologic studies were typical of this disorder. The diagnosis was suggested by CT scan, and confirmed on surgical biopsy. Our patient has had the typically benign course seen with mesenteric panniculitis.

[Sclerosing mesenteritis]

A patient with an inflammatory fibrous tumor of the mesenteric fat tissue is reported. Clinical signs were epigastric pain, weight loss and palpable abdominal mass. diagnosis was by abdominal CT and surgical biopsy. The histological feature was diffuse fibrosis. Isolated mesenteric fibrosis is a rare variety of systemic idiopathic fibrosis, a disease entity including fibrosis of the retroperitoneum and other sites. Among possible etiological factors an autoimmune origin, drugs (methysergide) and lymphatic obstruction are discussed. Our patient had congenital hypoplasia of the lymphatic drainage system of the legs. She recovered rapidly and spontaneously and the tumor regressed on CT. Fatal courses are exceptional and medical therapy usually is not required.