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Cortés P, Ghoz HM, Mzaik O, Alhaj Moustafa M, Bi Y, Brahmbhatt B, Daoud N, Pang M. Colchicine as an Alternative First-Line Treatment of Sclerosing Mesenteritis: A Retrospective Study. Dig Dis Sci 2022; 67:2403-2412. [PMID: 34086165 DOI: 10.1007/s10620-021-07081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 12/09/2022]
Abstract
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.
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Affiliation(s)
- Pedro Cortés
- Division of Medicine, Mayo Clinic Florida, Jacksonville, 32224, USA
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | | | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Nader Daoud
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Maoyin Pang
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Asghar MS, Tauseef A, Naman D, Zafar M, Rasheed U, Khan N, Alvi H, Shaikh N. Mesenteric Panniculitis in a Patient with Homozygous Factor V Leiden Gene Mutation: A Case and Literature to Review. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 30-year-old Asian male with a significant history of deep vein thrombosis and family history positive for pulmonary embolism presented with complaints of fever, nonradiating epigastric pain, and a sense of abdominal fullness. After the initial workup, ultrasonography of the whole abdomen was carried out which showed thrombus formation in the portal vein. A CT scan of the abdomen was performed, which showed findings suggestive of mesenteric panniculitis. Keeping the significant family history and imaging findings in mind, the clotting and thrombin profiles were analysed and came back positive for the factor V Leiden gene (homozygous). A CT angiogram was performed to demonstrate extensive thrombosis throughout the abdominal vasculature with cavernous transformation. It is asserted that the chronic thrombosis on a background of factor V mutation led towards chronic inflammation of the mesentery. To the authors’ knowledge it is the first reported case of mesenteric panniculitis in a patient with factor V homozygous gene mutation.
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Affiliation(s)
| | - Abubakar Tauseef
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Durre Naman
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Maryam Zafar
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Uzma Rasheed
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Narmin Khan
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Haris Alvi
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimra Shaikh
- Liaquat National Hospital and Medical College, Karachi, Pakistan
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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.
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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.
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Sclerosing mesenteritis: a systematic review of 192 cases. Clin J Gastroenterol 2017; 10:103-111. [DOI: 10.1007/s12328-017-0716-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/26/2017] [Indexed: 02/06/2023]
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Shah S, Mahy G, Roche E. Rare case of sclerosing mesenteritis and low grade follicular lymphoma. World J Clin Cases 2016; 4:108-111. [PMID: 27099861 PMCID: PMC4832116 DOI: 10.12998/wjcc.v4.i4.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/06/2015] [Accepted: 01/11/2016] [Indexed: 02/05/2023] Open
Abstract
An unusual case of long standing sclerosing mesenteritis; initially presented with recurrent abdominal pain and a mesenteric mass with surrounding fat oedema and stranding with a pseudocapsule and fat ring sign were clearly visualised on the initial computed tomography scan. Laparotomy showed diffuse thickening at the root of the mesentery and histology from this specimen revealed fat necrosis and reactive lymphoid tissue consistent with sclerosing mesenteritis. Initial treatment with steroids and tamoxifen relieved the symptoms and the mass. He was maintained on tamoxifen. Three years later he developed a recurrence of his symptoms and abdominal mass that responded to a course of steroids. Two years following this, he developed a follicular Hodgkin’s lymphoma.
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Lin PY, Lou HY, Chang CC. A rare cause of diffuse abdominal pain and fullness in a 57-year-old man. Gastroenterology 2014; 147:e5-6. [PMID: 24973681 DOI: 10.1053/j.gastro.2014.02.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/21/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Pao-Ying Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Horng-Yuan Lou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Endo K, Moroi R, Sugimura M, Fujishima F, Naitoh T, Tanaka N, Shiga H, Kakuta Y, Takahashi S, Kinouchi Y, Shimosegawa T. Refractory sclerosing mesenteritis involving the small intestinal mesentery: a case report and literature review. Intern Med 2014; 53:1419-27. [PMID: 24990334 DOI: 10.2169/internalmedicine.53.1813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 28-year-old Japanese man presented with upper abdominal pain. Computed tomography (CT) revealed a soft tissue mass in the small bowel mesentery. We diagnosed the patient with sclerosing mesenteritis according to the histological findings of small bowel mesentery. Although he was treated with prednisolone, colchicine and azathioprine, neither his symptoms nor CT findings improved. This case is rare in that the disease was refractory. The characteristics of Japanese patients with sclerosing mesenteritis involving small bowel mesentery are not well understood. We herein describe the details of such patients based on a literature review including 32 recently reported Japanese cases.
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Affiliation(s)
- Katsuya Endo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
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Fasoulas K, Beltsis A, Katsinelos T, Dimou E, Arvaniti M, Charsoula A, Gourvas V, Atmatzidis S, Chatzimavroudis G, Katsinelos P. Efficacy of colchicine in the treatment of mesenteric panniculitis in a young patient. Saudi J Gastroenterol 2012; 18:146-8. [PMID: 22421723 PMCID: PMC3326978 DOI: 10.4103/1319-3767.93825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mesenteric panniculitis (MP) is a rare inflammatory and fibrotic disease of the mesentery of unknown etiology. It has various clinical and radiological manifestations, posing a diagnostic challenge for clinicians. Its diagnosis is indicated via radiologic imaging and is usually confirmed via peritoneal biopsies. We describe a case of a patient with histopathologically proven MP, in which steroid dependence was successfully managed with colchicine.
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Affiliation(s)
- Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | - Athanasios Beltsis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Eleni Dimou
- Department of Pharmacy, Aristotle University of Thessaloniki, Greece
| | - Mary Arvaniti
- Department of Radiology, Central Hospital, Thessaloniki, Greece
| | - Anna Charsoula
- Department of Radiology, Central Hospital, Thessaloniki, Greece
| | - Victor Gourvas
- Department of Histopathology, Central Hospital, Thessaloniki, Greece
| | - Stefanos Atmatzidis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece,Address for correspondence: Prof. Panagiotis Katsinelos, Assistant Professor of Gastroenterology Head, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece. E-mail:
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Multidetector-row computed tomography findings of sclerosing mesenteritis with associated diseases and its prevalence. Jpn J Radiol 2011; 29:495-502. [PMID: 21882092 DOI: 10.1007/s11604-011-0587-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 03/09/2011] [Indexed: 12/15/2022]
Abstract
PURPOSE Our aim was to report the multidetector-row computed tomography (MDCT) findings of sclerosing mesenteritis, which is a rare disease characterized by chronic nonspecific inflammation of mesenteric adipose tissue. It has associated diseases, and we explored its prevalence. MATERIALS AND METHODS A total of 2100 patients were evaluated retrospectively for sclerosing mesenteritis between December 2007 and May 2009. Signs and symptoms, associated diseases, laboratory data, surgical histories, and related findings of a misty mesentery, which corresponds to sclerosing mesenteritis on MDCT, were recorded. RESULTS Misty mesentery findings were seen in 51 (2.43%; 35 men) patients. Their ages ranged between 33 and 78 years (mean 56.2 years). The most frequent complaint of patients was abdominal pain (n = 19; 37.2%). The most prominent possible causative and/or associated factors in our study were malignancy (n = 9; 17.6%), previous surgery (n = 17; 33.3%), smoking (n = 20; 39.2%), coronary artery disease (n = 9; 17.6%), urolithiasis (n = 10; 19.6%), hypertension (n = 18; 35.2%), hyperlipidemia (n = 13; 25.5%), and diabetes mellitus (n = 11; 21.5%). On MDCT, density values in mesenteric fat (-62.8 ± 18.6 HU) were significantly higher than the values for subcutaneous (-103.9 ± 5.8 HU) and retroperitoneal (-105 ± 6 HU) fatty tissues (both P < 0.0001). A partially hyperdense stripe (n = 37; 72.6%), well-defined soft tissue nodules (100%), hypodense fatty halo enclosing vessels (n = 1; 1.9%), and nodules (n = 12; 23.5%) were demonstrated in most of the patients. CONCLUSION The diagnosis of sclerosing mesenteritis has increased with the more frequent use of MDCT and the popularization of the DICOM viewer. Defined hallmarks on MDCT can be helpful for differentiating sclerosing mesenteritis from other pathologies.
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Dolor abdominal y pérdida de peso en un paciente con linfoma tratado en remisión completa. Rev Clin Esp 2011; 211:e19-21. [DOI: 10.1016/j.rce.2010.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/13/2010] [Accepted: 07/20/2010] [Indexed: 01/13/2023]
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Rothlein LR, Shaheen AW, Vavalle JP, Smith SV, Renner JB, Shaheen NJ, Tarrant TK. Sclerosing mesenteritis successfully treated with a TNF antagonist. BMJ Case Rep 2010; 2010:2010/dec17_1/bcr0720103145. [PMID: 22802373 DOI: 10.1136/bcr.07.2010.3145] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 29-year-old female presented with intermittent nausea, vomiting, fevers, abdominal pain and fatigue. CT scans of the abdomen revealed inflammatory changes within the mesentery and small bowel. Histopathology of the mesentery and omentum showed chronic inflammation and fibrosis, supporting a diagnosis of sclerosing mesenteritis. Over the past 2 years, the patient suffered debilitating paroxysmal abdominal pain despite treatment with prednisone, azathioprine, sulfasalazine and narcotics. Additionally, she developed sacroiliitis diagnosed clinically and on radiographs. Intravenous infliximab (5 mg/kg intravenous) was initiated and continued every 6 weeks for 3 years. The patient has since had a dramatic improvement in her back and abdominal symptoms and has tapered off of prednisone, azathioprine and narcotics. Erythrocyte sedimentation rate, anaemia, leukocytosis and radiographic findings improved after initiation with infliximab. In conclusion, the authors report successfully treating sclerosing mesenteritis with sacroiliitis by the addition of infliximab. This may implicate a role for tumour necrosis factor α in disease pathogenesis.
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Affiliation(s)
- Lisa R Rothlein
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Balestrim Filho A, Mercês RLD, Pisi PH, Braga TA, Almeida ALNR, Parra RS, Feres O, Rocha JJRD. Paniculite mesentérica (PM) e fibromatose mesentérica (FM): relato de casos. REVISTA BRASILEIRA DE COLOPROCTOLOGIA 2009; 29:389-392. [DOI: 10.1590/s0101-98802009000300016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
A paniculite mesentérica (PM) e a fibromatose mesentérica (FM) são doenças fibróticas de etiologia incerta. São mais frequentes no mesentério do intestino delgado, no grande omento e nos mesocólons. Clinicamente a FM pode apresentar-se de forma aguda na qual uma complicação da doença é sua primeira expressão. Na forma crônica é caracterizada por sintomas abdominais vagos e/ou massa abdominal palpável. A comprovação diagnóstica, assim como na PM, é feita através de laparotomia exploradora ou videolaparoscopia diagnóstica e biopsia. Os autores relatam dois casos sendo um de PM e outro de FM, apresentam um paralelo dos aspectos clínicos, tomográficos, diagnóstico, histopatológico e terapêutico destacando as semelhanças e as diferenças entre essas duas patologias.
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Hiridis S, Hadgigeorgiou R, Karakitsos D, Karabinis A. Sclerosing mesenteritis affecting the small and the large intestine in a male patient with non-Hodgkin lymphoma: a case presentation and review of the literature. J Med Case Rep 2008; 2:388. [PMID: 19091063 PMCID: PMC2615039 DOI: 10.1186/1752-1947-2-388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 12/17/2008] [Indexed: 11/29/2022] Open
Abstract
Introduction Sclerosing mesenteritis is a rare disease resembling a mesenteric tumour. We present here a case of sclerosing mesenteritis that affected both the large and the small intestine of the patient. Therapeutic and diagnostic issues are discussed. Case presentation A 62-year-old man with a history of non-Hodgkin lymphoma presented with fatigue, a palpable tender abdominal mass and clinical signs of progressing intestinal obstruction. The preoperative evaluation failed to prove recurrence of the lymphoma or any other definite diagnosis. A laparotomy was performed through a midline incision. The mesentery resembled a tumour-like thickened and fibrotic mass. Abundant, rigid intestinal loop adhesions were observed. Diffuse fibrotic infiltration of the ileum and of the sigmoid colon, which obviously affected the intestinal vascular supply, were identified. A right colectomy and partial sigmoidectomy were performed. Pathological evaluation revealed extensive myofibroblastic reaction of the mesentery with accompanying loci of fat necrosis and areas of inflammation. A diffuse fibrotic infiltration that focally showed a ground-glass appearance was observed. The post-operative course was complicated by respiratory insufficiency and infections and the patient died 2 months after the operation. Conclusion Sclerosing mesenteritis that affects both the small and the large intestine is extremely rare. The disease is characterized by myofibroblastic reaction, fat necrosis and diffuse fibrosis of the mesentery. Pathological confirmation may be required for definite diagnosis. If the disease is characterized by severe and diffuse fibrosis, then the application of surgical therapy may be problematic.
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Affiliation(s)
- Savvas Hiridis
- Intensive Care Unit, General Hospital of Athens, Athens, Greece.
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