Colon Perforation As Initial Presentation of Refractory and Complicated Sclerosing Mesenteritis

Idiopathic sclerosing mesenteritis presenting with small bowel volvulus in a patient with antiphospholipid syndrome: A case report

BACKGROUND

Sclerosing mesenteritis is a rare disorder involving inflammation of the mesentery. Its etiology remains unclear, but it is believed to be associated with previous abdominal surgery, trauma, autoimmune disorders, infection, or malignancy. Clinical manifestations of sclerosing mesenteritis are varied and include chronic abdominal pain, bloating, diarrhea, weight loss, formation of an intra-abdominal mass, bowel obstruction, and chylous ascites. Here, we present a case of idiopathic sclerosing mesenteritis with small bowel volvulus in a patient with antiphospholipid syndrome.

CASE SUMMARY

A 68-year-old female presented with recurrent small bowel obstruction. Imaging and pathological findings were consistent with sclerosing mesenteritis causing mesenteric and small bowel volvulus. Computed tomography scans also revealed pulmonary embolism, and the patient was started on a high dose of corticosteroid and a therapeutic dose of anticoagulants. The patient subsequently improved clinically and was discharged. The patient was also diagnosed with antiphospholipid syndrome after a hematological workup.

CONCLUSION

Sclerosing mesenteritis is a rare condition, and patients with no clear etiology should be considered for treatment with immunosuppressive therapy.

Peritoneal Cancer Mimicking Sclerosing Mesenteritis: A Case Report

Peritoneal cancer is a rare disease that typically affects middle-aged women. Sclerosing mesenteritis can have a benign or malignant etiology. Although computed tomography (CT) scan and magnetic resonance imaging have been used to differentiate these two diseases, the findings are not always conclusive. Here, we report the case of an older woman who presented with acute abdominal pain. She was initially diagnosed with sclerosing mesenteritis, but the final diagnosis was peritoneal cancer. The initial treatment included antibiotics, non-steroidal anti-inflammatory drugs, and prednisolone. Tamoxifen was administered due to persistent symptoms, which were alleviated. However, the patient’s cancer antigen 125 levels were elevated, and there were changes in the peritoneal CT findings. The patient was diagnosed with primary peritoneal cancer based on further investigation of the peritoneum using positron emission tomography-CT and a biopsy. This case report describes the diagnostic process regarding the differentiation between sclerosing mesenteritis and primary peritoneal cancer when the CT findings mimic those of sclerosing mesenteritis in general medicine.