51
|
Patel A, Alkawaleet Y, Young M, Reddy C. Mesenteric Panniculitis: An Unusual Presentation of Abdominal Pain. Cureus 2019; 11:e5100. [PMID: 31428545 PMCID: PMC6693797 DOI: 10.7759/cureus.5100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sclerosing mesenteritis is a rare autoimmune disease that eventually evolves into fibrotic changes that usually affect the adipose tissue around the mesenteric vessels. It can present through a myriad of gastroenterological as well as constitutional symptoms, including but not limited to abdominal pain, diarrhea, fever, nausea, or vomiting. Although the exact etiology of the disease is yet to be determined, there are several predisposing factors, the most common of which is a previous history of abdominal trauma and/or surgery. Several case series have reported the association of sclerosing mesenteritis with prior abdominal surgery ranging from as low as 24% to as high as 53%.
Collapse
Affiliation(s)
- Ankit Patel
- Miscellaneous, Quillen College of Medicine, East Tennessee State University, Johnson CIty, USA
| | - Yazan Alkawaleet
- Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Mark Young
- Gastroenterology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Chakradhar Reddy
- Gastroenterology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| |
Collapse
|
52
|
Abstract
Sclerosing mesenteritis is a rare benign disease presenting with chronic inflammation of the mesenteric adipose tissue and variable degrees of fibrosis. A 47-year-old black man presented to the emergency department with symptoms of small bowel obstruction, requiring surgical treatment. The laparotomy revealed a stenosis of the distal ileum with mesenteric thickening and an enterectomy was performed. The postoperative period was complicated by the maintenance of bowel obstruction. The patient underwent a second laparotomy, in which the fibrosing process of the mesentery was much aggravated, and an ileo-colic resection was needed. After knowledge of the histological diagnosis, the patient was started on immunomodulators with clinical improvement. At 26 months of follow-up, patient is asymptomatic under medical treatment. This is the first report, to our knowledge, of a patient with progressive fibrosis in such short period of time requiring surgical re-intervention for bowel obstruction, owing to sclerosing mesenteritis.
Collapse
Affiliation(s)
- Sofia Costa Corado
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Heitor Almeida
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | | |
Collapse
|
53
|
Abstract
Sclerosing mesenteritis is a rare non-neoplastic disorder characterized by fat necrosis, chronic inflammation, and fibrosis typically of the small bowel mesentery. Our understanding of this disorder is limited by its rarity as well as inconsistent terminology used across the literature. While prior abdominal surgery or trauma, autoimmunity, infection, ischemia, and malignancy have been suggested to be involved in the pathogenesis of the disorder, it remains poorly understood. The clinical course of sclerosing mesenteritis is generally benign with a large proportion of patients diagnosed incidentally on imaging obtained for other indications. In a subset of patients, symptoms may arise from a mass effect on the bowel, lymphatics, or vasculature resulting in bowel obstruction, chylous ascites, or mesenteric ischemia. Symptomatic patients should be treated with a combination of corticosteroid and tamoxifen as first-line therapy based on retrospective case series and experience in other fibrosing disorders. Surgical intervention may be required in those with persistent obstruction despite conservative treatment, though complete resection of the mass is often not feasible given intimate involvement with the mesenteric vasculature. A careful use of terminology and communication between the radiologist, pathologist, and clinicians in the care of these patients will be essential to future efforts at understanding this disease.
Collapse
|
54
|
Zhao ME, Zhang LQ, Ren L, Li ZW, Xu XL, Wang HJ, Wang ZX, Li HL, Bao YY, Fan HN, Yangdan CR. A case report of mesenteric panniculitis. J Int Med Res 2019; 47:3354-3359. [PMID: 31122101 PMCID: PMC6683908 DOI: 10.1177/0300060519845785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 65-year-old man had intermittent abdominal pain for the previous 2 years. This pain suddenly became worse with a fever and elevated inflammatory markers. We took a while to diagnose the patient with mesenteric panniculitis (MP). Although imaging findings suggested MP, we needed to rule out other diseases. Choosing a treatment for the patient also took some time and we finally used glucocorticoid to cure the patient.
Collapse
Affiliation(s)
- Ming-En Zhao
- 1 Medical College of Qinghai University, Xining, China.,2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Ling-Qiang Zhang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Li Ren
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Zhen-Wei Li
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Xiao-Lei Xu
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Jiu Wang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Zhi-Xin Wang
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Long Li
- 4 Department of Medical Central Imaging, The Affiliated Hospital of Qinghai University, Xining, China
| | - Yuan-Yuan Bao
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,4 Department of Medical Central Imaging, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hai-Ning Fan
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,3 Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
| | - Cai-Rang Yangdan
- 2 Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| |
Collapse
|
55
|
Rizos EC, Panagiotopoulou T, Liberopoulos E, Elisaf M, Tsili A, Argyropoulou MI, Tigas SK. IS MESENTERIC PANNICULITIS A SIGN FOR AUTOIMMUNE DIABETES IN ADULTS? AACE Clin Case Rep 2019; 5:e181-e183. [PMID: 31967029 PMCID: PMC6876940 DOI: 10.4158/accr-2018-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/01/2018] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Mesenteric panniculitis (MP) and sclerosing mesenteritis is an umbrella term used to describe a rare, chronic, and frequently benign fibrosing inflammatory disease that affects the adipose tissue of the mesentery. The diagnosis is usually based on imaging (computed tomography [CT] or magnetic resonance imaging) findings and is confirmed by biopsy. We report the unusual case of a patient with MP with typical CT findings and diabetes mellitus (DM). METHODS A 48-year-old male presented for symptomatic new onset DM. An abdominal CT scan revealed a well-defined mesenteric mass compatible with MP. The combination of insulin degludec and sitagliptin/metformin resulted in a decrease of HbA1c; however, this was followed by a subsequent gradual increase in HbA1c and positive glutamic acid decarboxylase auto-antibodies. RESULTS The patient developed auto-immune DM that was confirmed by the presence of auto-antibodies. CONCLUSION Panniculitis has been infrequently reported in patients with type 2 DM. This is the first report of a patient with MP correlated with auto-immune DM. The possible pathophysiologic mechanisms are discussed.
Collapse
|
56
|
Kwon TH, Cho KB, Lee HJ, Kwon SY, Lee YS. [Immunoglobulin G4 Unrelated Idiopathic Mesenteric Sclerosis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:50-55. [PMID: 30690959 DOI: 10.4166/kjg.2019.73.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/23/2018] [Accepted: 06/24/2018] [Indexed: 11/03/2022]
Abstract
Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16-3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.
Collapse
Affiliation(s)
- Tae Hyung Kwon
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Jik Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sun Young Kwon
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Suk Lee
- Division of Gastroenterology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
57
|
Rivera ED, Coffey JC, Walsh D, Ehrenpreis ED. The Mesentery, Systemic Inflammation, and Crohn's Disease. Inflamm Bowel Dis 2019; 25:226-234. [PMID: 29920595 DOI: 10.1093/ibd/izy201] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 12/11/2022]
Abstract
Initially thought to be a structure that only provided support to the abdominal contents, the mesentery has now gained special attention in the scientific community. The new approach of studying the mesentery as an individual organ has highlighted its importance in the development of local and systemic inflammatory diseases and its potential role in Crohn's disease. Its topographical relationship with the intestine in the setting of active inflammation and "creeping fat" is possibly one of the most important arguments for including the mesentery as an important factor in the pathogenesis of Crohn's disease. In this review, we discuss the importance of the mesentery from the anatomical and embryological standpoints. We also will summarize data on mesenteric inflammation in patients with Crohn's disease. The significance of the mesentery in systemic inflammatory syndromes will be discussed, and we provide an overview of primary inflammatory disorders of the mesentery. Finally, we discuss surgical approaches for patients requiring resection for Crohn's disease that incorporate mesenteric factors, pointing out recent data suggesting that these have the potential for improving outcomes and reducing disease recurrence. 10.1093/ibd/izy201_video1izy201.video15794169491001.
Collapse
Affiliation(s)
- Edgardo D Rivera
- Division of Gastroenterology, Hepatology and Nutrition, University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, Florida
| | - John Calvin Coffey
- FRCSI Surgery, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Department of Surgery, University Hospital Limerick Group, Limerick, Ireland
| | - Dara Walsh
- Department of Surgery, University Hospital Limerick Group, Limerick, Ireland
| | - Eli D Ehrenpreis
- Rosalind Franklin University Medical School, North Chicago, Illinois.,Division of Gastroenterology, Hepatology and Nutrition, University of Miami Miller School of Medicine, Miami, Florida.,Advocate Lutheran General Hospital, Park Ridge, Illinois
| |
Collapse
|
58
|
|
59
|
Sousa D, Varela AV, Coelho MV, Jorge C. Mesenteric panniculitis: diagnostic precision. BMJ Case Rep 2018; 2018:bcr-2017-223977. [PMID: 30317189 DOI: 10.1136/bcr-2017-223977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an elevated C reactive protein serum level. Serologies for infection were negative. Blood cultures grew no organisms. Colonoscopy revealed normal findings. CT showed typical findings of mesenteric panniculitis with infiltration of mesenteric fat that was circumscribed by hyperattenuating capsule and contained enlarged homogenous lymph nodes. The histopathological analysis from mesenterium revealed non-specific signs of chronic inflammation. On institution of prednisolone, the clinical symptoms subsided, and we replaced it with azathioprine after 1 month. After 12 months of therapy, the patient remained asymptomatic, normalised the serological inflammatory markers and repeat CT revealed normal mesenteric fat.
Collapse
Affiliation(s)
- Domingos Sousa
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana Verónica Varela
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Catarina Jorge
- Internal Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| |
Collapse
|
60
|
Mejías Manzano MDLÁ, Trigo Salado C, Serrano Jiménez M, Parada Blázquez MJ, Leo Carnerero E. IgG4-related sclerosing mesenteritis, a rare condition that causes abdominal pain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:201-203. [PMID: 29271222 DOI: 10.17235/reed.2017.5228/2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The identification of IgG4-related disease as a distinct immune-mediated condition encompassing disorders that were traditionally seen as idiopathic has been a revolution in the diagnostic and therapeutic algorithm in several medical fields. This condition usually involves multiple organs (isolated organ involvement is uncommon except in the pancreas) with characteristic histopathological findings. We report a case that was assessed due to abdominal pain and subsequently diagnosed with IgG4-related sclerosing mesenteritis. A comprehensive work-up of the case ruled out other conditions and a diagnosis of IgG4-related sclerosing mesenteritis was made according to radiographic and histopathological criteria.
Collapse
Affiliation(s)
| | - Claudio Trigo Salado
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, España
| | | | | | - Eduardo Leo Carnerero
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, España
| |
Collapse
|
61
|
Green MS, Chhabra R, Goyal H. Sclerosing mesenteritis: a comprehensive clinical review. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:336. [PMID: 30306075 DOI: 10.21037/atm.2018.07.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sclerosing mesenteritis is a rare disease entity initially described in 1924 with a prevalence reported to be less than 1%. Sclerosing mesenteritis is a comprehensive term used to describe three almost similar clinical entities including mesenteric panniculitis, retractile mesenteritis, and mesenteric lipodystrophy which only differ by their histology. The etiology of sclerosing mesenteritis is uncertain, but the disease has been associated with trauma, autoimmune disease, surgery, and malignancy. The typical presenting symptom is the abdominal pain, but sclerosing mesenteritis has a broad constellation of presenting symptoms which often makes consideration of the diagnosis unlikely. Treatment for this little-understood disease ranges from surgical intervention for patients presenting with obstructive symptoms to immunosuppressive medical therapy for patients presenting with pain. The purpose of this article is to provide an overview of the literature relevant to the diagnosis, etiology, and management of this condition in hopes of making physicians aware of this unique condition.
Collapse
Affiliation(s)
- Michael S Green
- Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Rajiv Chhabra
- Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| |
Collapse
|
62
|
Roberts J, Gonzalez RS, Revetta F, Shi C. Mesenteric tumour deposits arising from small-intestine neuroendocrine tumours are frequently associated with fibrosis and IgG4-expressing plasma cells. Histopathology 2018; 73:795-800. [PMID: 29943407 DOI: 10.1111/his.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/23/2018] [Indexed: 12/13/2022]
Abstract
AIMS Mesenteric tumour deposits frequently occur in small-intestine neuroendocrine tumours. In many instances, these mesenteric tumour deposits are surrounded by a dense fibrotic stroma and have associated lymphoplasmacytic inflammation. The aim of this study was to examine whether mesenteric tumour deposits in patients with small-intestine NETs neuroendocrine tumours show histological and immunophenotypic overlap with IgG4-related sclerosing mesenteritis. METHODS AND RESULTS Sixty-six mesenteric tumour deposits from 66 patients with small-intestine neuroendocrine tumours with blocks available for further studies were identified from our archives. Cases were assessed for clinicopathological features and the presence of IgG4-positive and IgG-positive plasma cells by immunohistochemistry. Ratios of IgG4-positive to IgG-positive plasma cells were calculated. Seventeen mesenteric tumour deposits (26%) showed >40 IgG4-positive plasma cells per high-power field, and the majority of cases (68%) showed at least some staining of IgG4-positive plasma cells. Mesenteric tumour deposits with >20 IgG4-positive plasma cells per high-power field tended to be larger (25.9 ± 13.0 mm versus 18.6 ± 15.8 mm; P = 0.07), and had more IgG-positive plasma cells (88 ± 24 versus 36 ± 37; P < 0.01) and a higher IgG4-positive/IgG-positive plasma cell ratio (0.66 ± 0.18 versus 0.17 ± 0.25; P < 0.01). All but one mesenteric tumour deposit with >20 IgG4-positve plasma cells had a ratio of >40%. CONCLUSIONS IgG4 expression is frequent in mesenteric tumour deposits from small-intestine neuroendocrine tumours. Undersampling of tumour on biopsies of mesenteric tumour deposits could potentially cause diagnostic confusion with IgG4-related sclerosing mesenteritis.
Collapse
Affiliation(s)
- Jordan Roberts
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Frank Revetta
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chanjuan Shi
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
63
|
Abstract
With the inclusion of mesentery, the total number of human organs has recently increased by one. The mesentery was formerly construed to be a complex, discontinuous anatomical structure simply serving as a support for organs in abdominal cavity. However, recent research has established the mesentery to be a far more simple and unfragmented organ. Newly emerging information on the mesentery has challenged some older pathophysiological concepts. This review briefly discusses the anatomy of the mesentery, historical perspective on the mesentery, embryology, drug metabolizing enzymes and transporters of the mesentery, and the mesentery's role in diseases. The possible impact of the mesentery on absorption, distribution, metabolism, and excretion (ADME) is also discussed.
Collapse
Affiliation(s)
- Aneesh A Argikar
- a Department of Pharmacokinetics , KinderPharm LLC , Exton , PA , USA
| | - Upendra A Argikar
- b Department of Pharmacokinetic Sciences , Novartis Institutes for BioMedical Research, Inc , Cambridge , MA , USA
| |
Collapse
|
64
|
Affiliation(s)
- Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kai-Sheng Liao
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chih-Jen Huang
- Department of General Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| |
Collapse
|
65
|
Brun C, Peiffer S, Tan A, Teixeira A. Anorexie douloureuse dans l’ischémie intestinale chronique. Presse Med 2018; 47:586-587. [DOI: 10.1016/j.lpm.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/26/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022] Open
|
66
|
|
67
|
Kobayashi H, Notohara K, Otsuka T, Kobayashi Y, Ujita M, Yoshioka Y, Suzuki N, Aoyagi R, Ohashi R, Suzuki T. An Autopsy Case of Mesenteric Panniculitis with Massive Pleural Effusions. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:13-20. [PMID: 29298971 PMCID: PMC5763981 DOI: 10.12659/ajcr.905744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mesenteric panniculitis (MP) is an idiopathic chronic inflammatory condition of the mesentery. The main symptoms include abdominal pain, abdominal distention, weight loss, fever, nausea, and vomiting. The patients also present with chylous ascites in 14% of the cases and chylous pleural effusion (CPE) in very rare occasions. Despite the previous view of excellent prognosis of MP, two recent papers reported several fatal cases. However, there are still only a few autopsy case reports that describe the macroscopic and histological details of MP cases. CASE REPORT The patient was an 81-year-old Japanese woman. She complained of edema of her lower legs and face, general fatigue, and dyspnea. She was overweight and had type 2 diabetes (T2D). Computerized tomography (CT) demonstrated massive bilateral pleural effusions, with mild pericardial effusion and mild ascites. There was no pulmonary, cardiac or hepatic condition to explain the effusions. However, MP was suspected based on her CT. She gradually deteriorated into respiratory failure. The autopsy revealed CPEs (left 1,300 mL, right 1,400 mL) and MP in the mesentery of the small intestine. Neither neoplasia nor inflammatory conditions other than MP were detected. CONCLUSIONS In rare occasions, patients with MP present with CPE or chylothorax. We thought that a possible mechanism of the CPEs was a diaphragmatic defect. We suspected that being overweight and T2D had an etiological relationship with MP in our patient's case. Adipose tissue of the mesentery is the main focus of MP. We believed that MP would be the best umbrella term of the many synonyms.
Collapse
Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kenji Notohara
- Department of Pathology, Kurashiki General Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Otsuka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuka Kobayashi
- Department of Oncology, Nagaoka Central Hospital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Naomasa Suzuki
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryuji Aoyagi
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Core Facility, Niigata University Faculty of Medicine, Niigata City, Niigata, Japan
| | - Toshimitsu Suzuki
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| |
Collapse
|
68
|
Mizuno S, Wakui M, Machida Y, Hosoe N, Hisamatsu T, Ishida T, Kameyama K, Naganuma M, Kanai T. Increased levels of prostaglandin E-major urinary metabolite (PGE-MUM) in active mesenteric panniculitis patients: A case report. Medicine (Baltimore) 2017; 96:e9237. [PMID: 29390478 PMCID: PMC5758180 DOI: 10.1097/md.0000000000009237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mesenteric panniculitis (MP) is a rare disease with abdominal and systemic symptoms and is characterized by nonspecific inflammation, fat necrosis, and fibrosis in mesenteric fat. Active inflammatory responses may increase levels of prostaglandin E-major urinary metabolite (PGE-MUM), which was reported to reflect the disease activity of ulcerative colitis and chronic fibrosing interstitial pneumonia. We recently experienced a case with elevated PGE-MUM at the time of diagnosis of MP and we investigated the potential of PGE-MUM as a biomarker. PATIENT CONCERN In this report we described 2 active mesenteric panniculitis patients with high PGE-MUM levels. DIAGNOSES Mesenteric panniculitis INTERVENTIONS:: Both MP patients were measured the levels of PGE-MUM. OUTCOMES Both MP patients exhibited high levels of PGE-MUM before treatment. In one, the levels were sensitively correlated with clinical symptoms and serological markers on steroids. LESSONS The study observations suggest the potential of PGE-MUM to reflect the disease activity of MP. To verify its use, more findings based on clinical studies should be accumulated.
Collapse
Affiliation(s)
- Shinta Mizuno
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | | | - Yujiro Machida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy
| | - Tadakazu Hisamatsu
- The Third Department of Internal Medicine, Kyorin University School of Medicine
| | | | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| |
Collapse
|
69
|
Ueno M, Nishimura N, Shimodate Y, Doi A, Mouri H, Matsueda K, Yamamoto H, Mizuno M. Sclerosing mesenteritis diagnosed with computed tomography and ultrasound-guided needle biopsy: the utility of the coaxial technique. Clin J Gastroenterol 2017; 11:92-95. [PMID: 29143914 DOI: 10.1007/s12328-017-0800-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
Here we report a case of sclerosing mesenteritis that we diagnosed with needle biopsy under the guidance of computed tomography (CT) and ultrasound (US) observation. An 82-year-old woman presented with appetite loss, weight loss and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel and enlarged lymph nodes. Sclerosing mesenteritis was suspected, but malignancies, such as lymphoma, were also considered. We performed CT and US-guided needle biopsy with the coaxial technique. An introducer needle was inserted, its correct location was documented with CT, and multiple specimens were taken with a finer needle passed through the introducer without incident. Adequate specimens were obtained, and the histological diagnosis of sclerosing mesenteritis was made. We treated the patient with corticosteroids and her symptoms and the radiographic findings improved. The coaxial technique was a useful and minimally invasive tool for making the diagnosis of sclerosing mesenteritis.
Collapse
Affiliation(s)
- Masayuki Ueno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Naoyuki Nishimura
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hiroshi Yamamoto
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| |
Collapse
|
70
|
Sclerosing mesenteritis as a presentation of myelodysplastic syndrome (MDS) with improvement following treatment targeted at MDS. Ann Hematol 2017; 97:547-549. [PMID: 29134269 DOI: 10.1007/s00277-017-3177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
|
71
|
Liang CP, Yang M, Chen PY, Geng LL, Li DY, Gong ST. Sclerosing mesenteritis in a 5-year-old Chinese boy: a case report. BMC Pediatr 2017; 17:179. [PMID: 28764764 PMCID: PMC5540191 DOI: 10.1186/s12887-017-0931-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
Background Sclerosing mesenteritis is a rare fibroinflammatory disorder of unknown etiology that primarily affects the mesentery of the small intestine during late adult life. Only about twenty pediatric cases have been reported to date, but none has been reported in Chinese children. Case presentation A 5-year-old Chinese male presented with a 4-week history of recurrent bloating, abdominal pain, anorexia and vomiting. On admission, physical examination showed a severely distended abdomen. Biochemical investigations showed a slightly increased C-reactive protein, and normal serum levels of electrolytes and erythrocyte sedimentation rate. An abdominal film showed small intestine obstruction and massive ascites. An exploratory laparotomy revealed widespread inflammatory fibrotic adhesions between the bowel and the abdominal wall, thickening of the small bowel and massive ascites. During a prolonged hospital course, a 2nd surgery (4 months after 1st exploratory laparotomy) was performed in order to close the ileostomy and revealed that the bowel was still severely edematous, with very tight adhesions between the bowel and the abdominal wall. Histopathological examination of excised mesentery and nodules showed chronic inflammatory cell infiltration, fat necrosis and fibrosis. A diagnosis of sclerosing mesenteritis was finally established. Prednisolone at 2 mg/kg was started and he experienced rapid clinical improvement in 4 weeks. Conclusions Sclerosing mesenteritis is extremely rare in children and often misdiagnosed due to its nonspecific clinical manifestation. It is important to be aware of sclerosing mesenteritis when evaluating a child with intractable abdominal pain, bloating, intestinal obstruction and massive ascites.
Collapse
Affiliation(s)
- Cui-Ping Liang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Min Yang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Pei-Yu Chen
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Lan-Lan Geng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Ding-You Li
- Department of Pediatrics, Division of Gastroenterology, University of Missouri-Kansas City, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Si-Tang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China.
| |
Collapse
|