Undiagnosed Sjögren's Syndrome Presenting as Mesenteric Panniculitis

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.

Mesenteric panniculitis

A 53-year-old black woman presented with a 3-day history of abdominal pain. Ultrasound of the abdomen showed a gall bladder packed with small stones. She gave a history of abdominal surgery for a gynaecological condition. She had a cholecystectomy done, but her symptoms continued after cholecystectomy. She then had anendoscopic retrograde cholangiopancreatogram (ERCP) and sphincterotomy done, again her symptoms remained the same. A CT scan of the abdomen was done, and mesenteric panniculitis was suspected. A laparoscopic biopsy of the mesentery was performed, and it confirmed mesenteric panniculitis. She was started on a 2-week course of steroids to which she responded very well. Three months after the initial presentation, she was still asymptomatic.