1
|
Bhatia H, Sinha A, Mishra A. Acute Epigastric Pain: Unexpected Urologic Findings on Computed Tomography. Urology 2023; 176:e10-e12. [PMID: 37030578 DOI: 10.1016/j.urology.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Mesenteric panniculitis is a relatively common condition encountered on cross-sectional imaging and is mostly asymptomatic. We present one such case where an underlying malignancy was brought to forefront due to associated mesenteric panniculitis presenting as acute abdomen.
Collapse
Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Anand Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
2
|
Fukuda M, Miyake T, Matsubara A, Ikai N, Tanaka E, Namura T, Wada Y, Noujima M, Moritani S, Murakami K, Andoh A, Tani M, Kushima R. Sclerosing Mesenteritis Mimicking IgG4-related Disease. Intern Med 2020; 59:513-518. [PMID: 31708540 PMCID: PMC7056383 DOI: 10.2169/internalmedicine.3221-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 72-year-old man was followed as an outpatient at our hospital for 6 years after surgery for small cell carcinoma of left adrenal gland origin. Follow-up abdominal computed tomography showed a 6-cm mass in the left lower mesentery. The patient underwent open laparotomy. The histological diagnosis was sclerosing mesenteritis. The previous specimens of the left adrenal mass were then re-examined with a microscope, and panniculitis was found around the small cell carcinoma. Both lesions were histologically similar to IgG4-related disease (RD), but they did not completely meet the diagnostic criteria of IgG4-RD clinically or histologically.
Collapse
Affiliation(s)
- Masahide Fukuda
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
- Department of Gastroenterology, Oita University, Faculty of Medicine, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Akiko Matsubara
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Nobuyasu Ikai
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Eri Tanaka
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Tomo Namura
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Yasuhiro Wada
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
- Department of Gastroenterology, Oita University, Faculty of Medicine, Japan
| | - Mai Noujima
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Suzuko Moritani
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University, Faculty of Medicine, Japan
| | - Akira Andoh
- Division of Gastrointestinal Endoscopy, Shiga University of Medical Science Hospital, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Japan
| | - Ryoji Kushima
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Japan
| |
Collapse
|
3
|
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. Am J Case Rep 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
4
|
Rey A, Busnelli VMC, Santino JP, Van Domselaar F, Quintana GO, Seehaus AC, De Paula JA. Extensive mesenteric lipodystrophy of the left colon: case report and brief review of the literature. Acta Gastroenterol Latinoam 2016; 46:43-47. [PMID: 29470884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mesenteric lipodystrophy is a rare inflammatory process that predominantly affects mesenteric adipose tissue of the small bowell. Several mechanisms have been suggested as responsible for this entity although the precise etiolog remains unknown. The diagnosis is based on CT or MRI imaging and generally confirmed by surgical biopsies. Treatment is individualized and empiric and depends on disease stage and symptoms. We report a case of a 35-year-old male who was admitted to our hospital with a history of abdominal pain, constipation and a palpable mass in the left lower quadrant. Abdominal CT scan showed diffuse thickening of the descending and rectosigmoid colon, associated with increased density of the mesenteric fat. After failure ofan initial treat- ment with glucocorticoids, he underwent a laparoscopic sigmoidectomy. Histopatholog analysis revealed extensive stea- tonecrosis ofpericolonicfat and lipid-ladenfoamy cells which was consistent with the diagnosis of mesenteric lipodystrophy. Clinical presentation and treatment as well as a brief review of the literature are discussed.
Collapse
|
5
|
Madubogwu CI, Okani CO. Sclerosing mesenteritis: A case of acute abdomen and intestinal obstruction. Niger J Med 2016; 25:86-89. [PMID: 29963834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Sclerosing mesenteritis (SM) is a rare idiopathic disorder characterized by chronic non-specific inflammation involving the adipose tissue of the bowel mesentery. It may be asymptomatic but it commonly presents with abdominal pain. Some individuals may have a palpable abdominal mass and affected individuals may develop small bowel obstruction or acute abdomen. We report a case of 27-year old man who presented to the Surgery Department at Chukwuemeka Odimegwu Ojukwu University Teaching Hospital (COOUTH), Amaku Awka, Anambra State with acute abdomen and intestinal obstruction. He subsequently, had a surgical resection, which was histologically confirmed as a sclerosing mesenteritis. Sclerosing mesenteritis is a rare disorder and this is the first case being reported in the literature from South-East, Nigeria.It is therefore, important to alert physicians, more especially the surgeons on the need to have a high index of suspicion in every case of intestinal obstruction.
Collapse
|
6
|
Hasegawa K, Akieda-Asai S, Fujii Y, Bae CR, Yasuda M, Date Y. Guanylin-Guanylyl cyclase-C signaling in macrophages regulates mesenteric fat inflammation induced by high-fat diet. Endocr J 2015; 62:939-47. [PMID: 26249840 DOI: 10.1507/endocrj.ej15-0193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Guanylin (Gn), a bioactive peptide, and its receptor, guanylyl cyclase-C (GC-C), are primarily present in the intestine and maintain homeostasis in body fluids. Recently, rats whose macrophages overexpress Gn and GC-C were found to be resistant to diet-induced obesity. Considering that obesity is strongly related to a chronic inflammatory state in white adipose tissues, it is possible that Gn-GC-C macrophages contribute to the regulation of inflammation. In the present study, we investigated the inflammatory state of mesenteric fat in rats transgenic for both Gn and GC-C (double-transgenic [dTg] rats) by evaluating the levels of cyclic guanosine monophosphate (cGMP), a second messenger of Gn-GC-C, cGMP-dependent protein kinase (PKG), and phosphorylated vasodilator-stimulated phosphoprotein (VASP), a target protein of PKG. The levels of cGMP in dTg rats was higher than in WT rats fed the same diet. Although there were no significant differences in levels of PKG and phosphorylated VASP between WT and dTg rats fed a standard diet (STD), these levels in dTg rats fed a high fat diet (HFD) were markedly increased compared with levels in HFD WT rats. Furthermore, mRNA levels of proinflammatory factors in mesenteric fat were lower in HFD dTg rats than in HFD WT rats and were similar to levels in STD WT and dTg rats. These results indicate that the Gn-GC-C system in macrophages regulates the cGMP-PKG-VASP pathway and controls obesity through the downregulation of proinflammatory factors.
Collapse
MESH Headings
- Animals
- Cell Adhesion Molecules/metabolism
- Cyclic GMP/metabolism
- Cyclic GMP-Dependent Protein Kinases/metabolism
- Diet, High-Fat/adverse effects
- Gastrointestinal Hormones/genetics
- Gastrointestinal Hormones/metabolism
- Immunohistochemistry
- Inflammation Mediators/metabolism
- Intra-Abdominal Fat/enzymology
- Intra-Abdominal Fat/immunology
- Intra-Abdominal Fat/metabolism
- Intra-Abdominal Fat/pathology
- Macrophages, Peritoneal/enzymology
- Macrophages, Peritoneal/immunology
- Macrophages, Peritoneal/metabolism
- Macrophages, Peritoneal/pathology
- Male
- Microfilament Proteins/metabolism
- Natriuretic Peptides/genetics
- Natriuretic Peptides/metabolism
- Obesity/etiology
- Obesity/immunology
- Obesity/metabolism
- Obesity/pathology
- Panniculitis, Peritoneal/etiology
- Panniculitis, Peritoneal/immunology
- Panniculitis, Peritoneal/metabolism
- Panniculitis, Peritoneal/pathology
- Phosphoproteins/metabolism
- Phosphorylation
- Protein Processing, Post-Translational
- Random Allocation
- Rats
- Rats, Transgenic
- Receptors, Enterotoxin
- Receptors, Guanylate Cyclase-Coupled/agonists
- Receptors, Guanylate Cyclase-Coupled/genetics
- Receptors, Guanylate Cyclase-Coupled/metabolism
- Receptors, Peptide/agonists
- Receptors, Peptide/genetics
- Receptors, Peptide/metabolism
- Second Messenger Systems
Collapse
Affiliation(s)
- Kazuya Hasegawa
- Frontier Science Research Center, University of Miyazaki, Miyazaki 889-1692, Japan
| | | | | | | | | | | |
Collapse
|
7
|
Fukuda S, Miyaoka Y, Tsukano K, Ueno S, Izumi D, Yamanouchi S, Yazaki T, Sonoyama T, Ito S, Fujishiro H, Kohge N, Imaoka T. [A case of sclerosing mesenteritis diagnosed on the basis of biopsy findings obtained during laparotomy and successfully treated with steroids]. Nihon Shokakibyo Gakkai Zasshi 2014; 111:2303-2310. [PMID: 25482906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 53-year-old female who complained of constipation and abdominal fullness was referred to our hospital. A tender low abdominal mass was palpable. Imaging (abdominal ultrasonography, CT, and MRI) revealed that the tumor had spread to the mesosigmoid and the superior mesentery. The tumor was very difficult to diagnose on the basis of imaging alone. Therefore, we obtained a biopsy at the time of laparotomy for definitive diagnosis. The biopsy showed extensive fibrosis and lymphocyte, plasma cell, and eosinophil infiltration in the associated adipose tissue. Sclerosing mesenteritis was diagnosed. The patient's symptoms improved immediately after initiating steroid therapy. Pathological examination and empirical steroid therapy are useful for the diagnosis and medical treatment of sclerosing mesenteritis, respectively.
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Katsuya Endo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Nabzdyk CS, Dermody M, Rhee J, Bankoff M, Weinstein B, Orkin BA. Progression of sclerosing mesenteritis into intra-abdominal abscesses. Am Surg 2013; 79:E25-E27. [PMID: 23317596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Christoph S Nabzdyk
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts 02111, USA
| | | | | | | | | | | |
Collapse
|
10
|
Avelino-Silva VI, Leal FE, Coelho-Netto C, Cotti GCDC, Souza RAS, Azambuja RL, Rocha MDS, Kallas EG. Sclerosing mesenteritis as an unusual cause of fever of unknown origin: a case report and review. Clinics (Sao Paulo) 2012; 67:293-5. [PMID: 22473414 PMCID: PMC3297042 DOI: 10.6061/clinics/2012(03)16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
11
|
Rolff HC, Fallentin E, Wettergren A. [Mesenteric panniculitis is a rare inflammation of the mesenteric adipose tissue]. Ugeskr Laeger 2011; 173:1437-1438. [PMID: 21586252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mesenteric panniculitis (MP) is a rare condition affecting the mesentery of the small bowel and/or colon. Obtaining a diagnosis is dependent on radiological and histological findings. With the increasing use of abdominal CT, more cases of MP will be discovered. We report a case of MP accidentally found at CT in a 64 year-old woman who was evaluated for upper abdominal discomfort. Percutaneous ultrasonography guided biopsy secured the diagnosis. There is no consensus on the treatment and management of MP. An approach guided by the patient's symptoms seems suitable.
Collapse
Affiliation(s)
- Hans Christian Rolff
- Kirurgisk Gastroenterologisk Klinik, Abdominalcentret, Rigshospitalet, 2100 København Ø, Denmark
| | | | | |
Collapse
|
12
|
Kida T, Suzuki K, Matsuyama T, Okita M, Isozaki Y, Matsumoto N, Miki S, Nagao Y, Kawabata K, Kohno M, Oyamada H. Sclerosing mesenteritis presenting as protein-losing enteropathy: a fatal case. Intern Med 2011; 50:2845-9. [PMID: 22082901 DOI: 10.2169/internalmedicine.50.5251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Sclerosing mesenteritis is a rare, benign disorder characterized by non-specific and chronic inflammation of the mesenteric adipose tissue. The disease usually presents with gastrointestinal symptoms and abdominal masses. The long-term prognosis is favorable, but it often becomes severe. In the present report we describe a 77-year-old man who presented with diarrhea, massive ascites and an abdominal mass. The rapid deterioration of the general condition of the patient limited invasive examinations and left the primary disease unclear. Despite symptomatic therapy, malnutrition and hypovolemia were prolonged, and he died. The definitive diagnosis of sclerosing mesenteritis and the cause of the fatal outcome were disclosed at autopsy. This case indicates that sclerosing mesenteritis is a potentially-fatal disease and the need for aggressive treatment should be discussed.
Collapse
Affiliation(s)
- Takashi Kida
- Department of Gastrointestinal Medicine, Matsushita Memorial Hospital, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Retractile mesenteritis is a rare, fibrosing, inflammatory disease affecting the adipose tissue of the intestinal and colonic mesentery. So far, about 300 cases have been reported in the literature. We present a case of retractile mesenteritis.
Collapse
Affiliation(s)
- K Psarras
- 2nd Propedeudical Department of Surgery, Hippokration Hospital, A' Bldg, 5th Floor, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
| | | | | | | | | | | | | |
Collapse
|
14
|
Hassan T, Balsitis M, Rawlings D, Shah AA. Sclerosing mesenteritis presenting with complete small bowel obstruction, abdominal mass and hydronephrosis. Ir J Med Sci 2010; 181:393-5. [PMID: 20506043 DOI: 10.1007/s11845-010-0495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
Sclerosing mesenteritis is an uncommon and poorly understood inflammatory condition of the bowel mesentery which can often be confused with neoplasia, Crohn's disease and other inflammatory conditions. We describe a case of complete small bowel obstruction and right sided hydronephrosis due to sclerosing mesenteritis.
Collapse
Affiliation(s)
- T Hassan
- Department of Gastroenterology, Crosshouse Hospital, Kilmarnock, KA2 0BE, UK.
| | | | | | | |
Collapse
|
15
|
|
16
|
Ramachandran V, Vydehi BV. An unusual case of intestinal obstruction. Trop Gastroenterol 2009; 30:222-225. [PMID: 20426284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Vijay Ramachandran
- Department of Surgical Gastroenterology, Narayana Medical College & Hospital, Chinthareddypalem, Nellore, Andhra Pradesh.
| | | |
Collapse
|
17
|
Nieuwdorp M, Nio CY, Bartelsman JFWM, Hoekstra JBL. Intermitting umbilical pain, fever and weight loss in an otherwise healthy 65-year-old male. Neth J Med 2009; 67:334-335. [PMID: 19767660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- M Nieuwdorp
- Department of Internal Medicine, Radiology and Gastroenterology, Academic Medical Centre-University, of Amsterdam, Amsterdam, the Netherlands.
| | | | | | | |
Collapse
|
18
|
Li H, Lelliott C, Håkansson P, Ploj K, Tuneld A, Verolin-Johansson M, Benthem L, Carlsson B, Storlien L, Michaëlsson E. Intestinal, adipose, and liver inflammation in diet-induced obese mice. Metabolism 2008; 57:1704-10. [PMID: 19013294 DOI: 10.1016/j.metabol.2008.07.029] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 07/03/2008] [Indexed: 12/23/2022]
Abstract
Chronic inflammation and increased visceral adipose tissue (VAT) are key elements of the metabolic syndrome. Both are considered to play a pathogenic role in the development of liver steatosis and insulin resistance. The aim of the present study was to investigate the hypothesis that an inflamed intestine, induced both by diet and chemical irritation, could induce persistent inflammation in VAT. Female C57BL/6JOlaHsd mice were used. In study I, groups of mice (n = 6 per group) were given an obesity-inducing cafeteria diet (diet-induced obesity) or regular chow only (control) for 14 weeks. In study II, colitis in mice (n = 8) was induced by 3% dextran sulfate sodium in tap water for 5 days followed by 21 days of tap water alone. Healthy control mice (n = 8) had tap water only. At the end of the studies, all mice were killed; and blood and tissues were sampled and processed for analysis. Body weight of diet-induced obese mice was greatly increased, with evidence of systemic inflammation, insulin resistance, and liver steatosis. Tissue inflammation indexed by proinflammatory cytokine expression was recorded in liver, mesenteric fat, and proximal colon/distal ileum, but not in subcutaneous or perigonadal fat. In dextran sulfate sodium-induced colitis mice, mesenteric fat was even more inflamed than the colon, whereas a much milder inflammation was seen in liver and subcutaneous fat. The studies showed both diet- and colitis-initiated inflammation in mesenteric fat. Fat depots contiguous with intestine and their capacity for exaggerated inflammatory responses to conditions of impaired gut barrier function may account for the particularly pathogenic role of VAT in obesity-induced metabolic disorders.
Collapse
MESH Headings
- Animals
- Body Weight/physiology
- Cytokines/blood
- Cytokines/metabolism
- Diet, Atherogenic
- Female
- Gastroenteritis/blood
- Gastroenteritis/complications
- Gastroenteritis/pathology
- Gastroenteritis/veterinary
- Hepatitis, Animal/blood
- Hepatitis, Animal/complications
- Hepatitis, Animal/pathology
- Intestinal Mucosa/metabolism
- Intestines/pathology
- Intra-Abdominal Fat/metabolism
- Intra-Abdominal Fat/pathology
- Liver/metabolism
- Liver/pathology
- Mice
- Mice, Inbred C57BL
- Mice, Obese
- Obesity/complications
- Obesity/etiology
- Obesity/pathology
- Obesity/veterinary
- Organ Size
- Panniculitis, Peritoneal/blood
- Panniculitis, Peritoneal/complications
- Panniculitis, Peritoneal/pathology
- Panniculitis, Peritoneal/veterinary
Collapse
Affiliation(s)
- Hong Li
- Department of Integrative Pharmacology, AstraZeneca R&D Mölndal, S-431 83 Mölndal, Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- Teresa Cristina A. Ferrari
- Department of Internal Medicine, Federal University of Minas Gerais, School of Medicine - Belo Horizonte/MG, Brazil
| | - Carolina M. Couto
- Department of Internal Medicine, Federal University of Minas Gerais, School of Medicine - Belo Horizonte/MG, Brazil
| | - Tatiane S. Vilaça
- Department of Internal Medicine, Federal University of Minas Gerais, School of Medicine - Belo Horizonte/MG, Brazil
| | - Marcelo A. P. Xavier
- Department of Pathology and Legal Medicine, Federal University of Minas Gerais, School of Medicine - Belo Horizonte/MG, Brazil.
Tel.: 55 31 3409.9746
| | - Luciana C. Faria
- Department of Internal Medicine, Federal University of Minas Gerais, School of Medicine - Belo Horizonte/MG, Brazil
| |
Collapse
|
20
|
Abstract
Mesenteric lipodystrophy is a rare pathological condition affecting the mesentery. Its initial presentation is typically asymptomatic. Pathological characteristics are unspecific, and generally attributed to inflammation, unless the diagnosis is suspected. Laparoscopy done for other reasons has been, as in this case, unsuccessful in providing evidence for the correct diagnosis, thus requiring laparotomy due to lack of diagnostic tissue. After 6 mo no further medical therapy is required, as the patient remains asymptomatic. Discussion of this case and a brief review of the literature are presented in the following paragraphs.
Collapse
Affiliation(s)
- Nereo Vettoretto
- General and Vascular Surgery, Az. Osp. M. Mellini, V.le Mazzini 4, Chiari (BS) 25032, Italy.
| | | | | | | | | | | |
Collapse
|
21
|
Jin M. [Sclerosing mesenteritis: report of a case]. Zhonghua Bing Li Xue Za Zhi 2007; 36:501-2. [PMID: 17845771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
22
|
Affiliation(s)
- Pradipta Ghosh
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, USA
| | | |
Collapse
|
23
|
Abstract
Retractile mesenteritis is a rare, idiopathic condition characterized by nonspecific inflammation of the mesenteric adipose tissue. The majority of patients present with abdominal pain and/or a palpable mass. In the present report, a 68-year-old man with peripheral edema and mild hypoalbuminemia is presented. Protein-losing gastro-enteropathy was confirmed with an abnormal stool alpha1-antitrypsin clearance test and retractile mesenteritis was diagnosed at laparoscopy. This rare condition may respond to therapy with corticosteroids, azathioprine, cyclophosphamide, colchicine, progesterone, tamoxifen or thalidomide. Gastroenterologists should consider the diagnosis of protein-losing enteropathy in patients who present with unexplained peripheral edema or hypoalbuminemia. The test of choice to confirm this diagnosis is the stool alpha1-antitrypsin clearance test.
Collapse
Affiliation(s)
| | - Donald R Duerksen
- Correspondence: Dr Donald R Duerksen, Division of Gastroenterology, C5120–409 Tache Avenue, Saint Boniface General Hospital, Winnipeg, Manitoba R2H 2A6. Telephone 204-237-2796, fax 204-233-7154, e-mail
| |
Collapse
|
24
|
Béchade D, Durand X, Desramé J, Rambelo A, Corberand D, Baranger B, Farge D, Algayres JP. [Etiologic spectrum of mesenteric panniculitis: report of 7 cases]. Rev Med Interne 2007; 28:289-95. [PMID: 17316921 DOI: 10.1016/j.revmed.2006.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 12/30/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Mesenteric panniculitis is a rare disorder characterized by nonspecific inflammation and/or necrosis and/or fibrosis in the adipose tissue of the bowel mesentery. Its signification, primary or associated with other diseases, is a subject of controversy. METHODS A descriptive and retrospective study of patients with an abdominal CT examination showing features of mesenteric panniculitis and for whom biopsy with immunohistochemical examination was obtained in all cases. RESULTS Seven patients were enrolled (4 men and 3 women) with a median age of 62,1 years. None of the patients without an identified etiology had a history of abdominal surgery. An associated disease was identified in 4 cases: breast cancer (1), non-Hodgkin's lymphoma based on peripheric lymph nodes biopsy (2) and cryoglobulinemic vascularitis based on renal biopsy (1). In the 3 remaining cases, isolated mesenteric panniculitis was the only abnormality despite thorough imaging and pathologic investigations. CONCLUSION Except an obvious malignancy context or a history of abdominal surgery, a pathologic examination of the mesenteric panniculitis lesions is necessary, especially to eliminate another mesenteric disorder. Mesenteric panniculitis is often associated with lymphoma.
Collapse
Affiliation(s)
- D Béchade
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- K Kishimoto
- First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
For the first time we describe a sclerosing mesenteritis that appeared acutely after abdominal operations. The patient suffered from diffuse abdominal symptoms. There was a hard tumour in the left middle and lower abdomen. Histological analysis revealed fibrosis and bone tissue. Symptoms improved after application of prednisone and high-calorie infusions.
Collapse
Affiliation(s)
- H Frickmann
- Urologische Klinik, Katharina-Kasper-Kliniken, St. Elisabethen-Krankenhaus, Ginnheimer Strasse 3, 60487, Frankfurt/M., Deutschland.
| | | | | | | | | |
Collapse
|
27
|
Iwanicki-Caron I, Savoye G, Legros JR, Savoye-Collet C, Herve S, Lerebours E. Successful management of symptoms of steroid-dependent mesenteric panniculitis with colchicine. Dig Dis Sci 2006; 51:1245-9. [PMID: 16944021 DOI: 10.1007/s10620-006-8044-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 07/21/2005] [Indexed: 02/06/2023]
Affiliation(s)
- Isabelle Iwanicki-Caron
- ADEN EA 3234, Department of Gastroenterology and Nutrition, Rouen University, Hospital C. Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France
| | | | | | | | | | | |
Collapse
|
28
|
Morin AS, Bellier C, Couvelard A, Zarrouk V, Belmatoug N, Fantin B, de Korwin JD. [Where are you, wolf?]. Rev Med Interne 2005; 26 Suppl 2:S208-12. [PMID: 16129148 DOI: 10.1016/s0248-8663(05)80028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- A-S Morin
- Service de médecine interne, CHU Beaujon, Clichy, France
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Sclerosing mesenteritis is a rare, usually benign disorder of the mesentery. Depending on the predominant tissue component (inflammation, fat, or fibrosis), it is known as mesenteric panniculitis or retractile mesenteritis. We present a rare case of retractile mesenteritis of the mesocolon as a cause of severe abdominal pain. US, CT, and MRI were the imaging modalities used. We emphasize the MR finding of a fibrous capsula in retractile mesenteritis, as this is to our knowledge the first study to describe this entity. This finding may be valuable for establishing a diagnosis of sclerosing mesenteritis, as well as for differentiating this disease from other mesenteric diseases.
Collapse
Affiliation(s)
- Nadir Ghanem
- Department of Diagnostic Radiology, University Hospital Freiburg, 79106 Freiburg, Germany.
| | | | | | | | | |
Collapse
|
30
|
Abstract
Sclerosing mesenteritis is a rare benign process involving mesenteric fat that has non-specific histology and imaging characteristics, which are critical to the diagnosis. It has two different pathological variants: mesenteric panniculitis (acute or subacute) and retractile mesenteritis (chronic). This case study illustrates the radiological findings of sclerosing mesenteritis, describes certain signs that suggest the diagnosis and reviews recent published literature.
Collapse
Affiliation(s)
- B White
- Department of Radiology, North-Western Adelaide Health Service, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
| | | | | |
Collapse
|
31
|
Kebapçi M, Adapinar B, Kaya T, Kebapçi N. [Mesenteric panniculitis of the colon: barium enema, US, CT, and MRI findings (case report)]. Tani Girisim Radyol 2004; 10:284-8. [PMID: 15611917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Mesenteric panniculitis as an uncommon disease of unknown etiology characterised by nonspecific inflammation of the fat tissue of the mesentery. In this report, we are presenting a case of mesenteric panniculitis of the rectosigmoid colon in which characteristic findings of barium enema, ultrasonography, computed tomography, and magnetic resonance imaging were noted. We emphasized the diagnostic significance of these methods.
Collapse
Affiliation(s)
- Mahmut Kebapçi
- Osmangazi Universitesi Tip Fakültesi, Radyoloji Anabilim Dali, Eskişehir, Turkey
| | | | | | | |
Collapse
|
32
|
Mathew J, McKenna F, Mason J, Haboubi NY, Borghol M. Sclerosing mesenteritis with occult ileal perforation: report of a case simulating extensive intra-abdominal malignancy. Dis Colon Rectum 2004; 47:1974-7. [PMID: 15622594 DOI: 10.1007/s10350-004-0639-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sclerosing mesenteritis is a rare condition that is characterized by fibrosis affecting mainly small-bowel mesentery, which in extensive cases may mimic advanced intra-abdominal malignancy. Establishing the diagnosis in such cases is a clinical and histopathologic challenge. We report the successful management of a case of extensive sclerosing mesenteritis with occult ileal perforation, which was possibly the triggering cause. Severe complications occurred as a result of both the disease itself and its surgical treatment. Despite the complex course and life-threatening complications, a good prognosis can be expected. Although occasional recovery has been attributed to spontaneous regression and response to immunosuppressive therapy, a search for, and full eradication of, possible triggering focus is of paramount importance.
Collapse
Affiliation(s)
- John Mathew
- Department of Surgery, Trafford General Hospital, Manchester, United Kingdom.
| | | | | | | | | |
Collapse
|
33
|
Ruiz P, Suarez M, Nishida S, de la Cruz V, Nicolas M, Weppler D, Khaled A, Bejarano P, Kato T, Mittal N, Icardi M, Tzakis A. Sclerosing mesenteritis in small bowel transplantation: possible manifestation of acute vascular rejection. Transplant Proc 2004; 35:3057-60. [PMID: 14697979 DOI: 10.1016/j.transproceed.2003.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Acute rejection of human small bowel allografts is characterized by clinical symptoms combined with characteristic morphologic alterations. The typical geographic distribution of acute rejection in the bowel is involvement of the intestinal parenchyma, which can be transmural, particularly when the rejection is more severe. However, little is known concerning the potential for donor-derived soft tissue adjacent to the bowel to become involved by the host alloimmune response. METHODS We describe a male patient who, several weeks after combined small bowel and liver transplantation, demonstrated sclerosing mesenteritis with vasculitis and acute rejection of the bowel. RESULTS The vascular lesions in the mesentery demonstrated increased IgG deposition and the patient developed an alloantibody to the donor. CONCLUSIONS The changes described herein may represent a novel presentation of acute vascular rejection.
Collapse
Affiliation(s)
- P Ruiz
- Department of Pathology, University of Miami School of Medicine, J M H Holtz Center #2101, 1611 NW 12th Avenue, Miami, FL 33101, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- P K Bos
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | | |
Collapse
|
35
|
Abstract
Sclerosing mesenteritis is a rare, combined inflammatory and fibrotic process of unknown etiology. Detailed cross-sectional imaging of this entity has been reported with computed tomography. The author presents an additional case of sclerosing mesenteritis demonstrated on fluorine-18 fluorodeoxyglucose positron emission tomography with multidetector computed tomographic correlation.
Collapse
Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Arizona 85259, USA.
| |
Collapse
|
36
|
Martínez Odriozola P, García Jiménez N, Cabeza García S, Oceja Barrutieta E. [Sclerosing mesenteritis. Report of two cases with different clinical presentation]. An Med Interna 2003; 20:254-6. [PMID: 12831301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Sclerosing mesenteritis is a rare disease of the mesenterium of unknown cause and chronic evolution. Two presentations have been reported: mesenteric panniculitis and retractile mesenteritis; inflammation of mesenteric fat predominates in one of them, while fibrotic thickening and shortening of the mesenterium is characteristic of the other. We report two cases of sclerosing mesenteritis which presented in very different ways. One patient suffered an episode of intestinal obstruction, and the second one was admitted for evaluation of fever of unknown origin (FUO). While intestinal obstruction is a relatively common complication of sclerosing mesenteritis, its presentation as a FUO is exceptional.
Collapse
|
37
|
Ogata T, Yoshimura A, Kurihara Y, Unakami M. [A case report of mesenteric panniculitis of vermiform appendix]. Nihon Shokakibyo Gakkai Zasshi 2002; 99:605-9. [PMID: 12099006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Takashi Ogata
- Division of Gastroenterology, Saiseikai Fukushima General Hospital
| | | | | | | |
Collapse
|
38
|
Lawler LP, McCarthy DM, Fishman EK, Hruban R. Sclerosing mesenteritis: depiction by multidetector CT and three-dimensional volume rendering. AJR Am J Roentgenol 2002; 178:97-9. [PMID: 11756096 DOI: 10.2214/ajr.178.1.1780097] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Leo P Lawler
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N. Caroline St., Rm. 3254, Baltimore, MD 21287, USA
| | | | | | | |
Collapse
|
39
|
Abstract
Sclerosing mesenteritis is an uncommon benign condition that should be included in the differential diagnosis of abdominal masses. We present the first reported case of this condition in association with idiopathic bile duct fibrosis simulating Klatskin's tumor. A review of the literature regarding both clinical entities is presented.
Collapse
Affiliation(s)
- H Medina-Franco
- Department of Surgery, The University of Alabama at Birmingham, USA.
| | | | | | | | | |
Collapse
|
40
|
Johst U, Horger M. [Mesenteric panniculitis]. ROFO-FORTSCHR RONTG 2001; 173:M187-8. [PMID: 11526912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
|
41
|
Seo M, Okada M, Okina S, Ohdera K, Nakashima R, Sakisaka S. Mesenteric panniculitis of the colon with obstruction of the inferior mesenteric vein: report of a case. Dis Colon Rectum 2001; 44:885-9. [PMID: 11391153 DOI: 10.1007/bf02234714] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mesenteric panniculitis is a rare disease characterized by nonspecific inflammation of the fat tissue of the mesentery. We present an extremely rare case of mesenteric panniculitis of the sigmoid colon, complicated by occlusion of the inferior mesenteric vein. A 75-year-old male presented with a one-month history of abdominal distention and abdominal mass without pain. Physical examination revealed a firm mass in the lower abdomen. Barium enema study demonstrated rugged mucosa and a serrated contour in the rectosigmoid colon. Computed tomography showed that the mass arose from the mesentery, which surrounded the mesenteric vessels. The density of the mass was slightly higher than that of fatty tissue. Based on these radiologic findings, the patient was diagnosed as having mesenteric panniculitis of the rectosigmoid colon. Colonoscopy showed narrowing with edematous mucosa in the rectosigmoid colon, whereas marked dilated vessels were noted in the proximal portion of the sigmoid colon. Angiography showed occlusion of the inferior mesenteric vein, with venous flow returning via a collateral vein. The patient was observed without medication because his condition was satisfactory. His symptoms subsequently disappeared during a period of several weeks. The mass in the lower abdomen gradually diminished in size, disappearing three months later. Computed tomography and barium enema showed improvement of the lesion. The favorable outcome of the present case was probably because of formation of a collateral vein. The present case suggests that aggressive therapy for mesenteric panniculitis should be avoided, because the outcome of this disorder is good, even when there is obstruction of vessels.
Collapse
Affiliation(s)
- M Seo
- Third Department of Internal Medicine, Fukuoka University, Japan
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
Mesenteric panniculitis is a rare disease of the bowel mesentery, characterized by tumor-like infiltration by chronic inflammatory cells, fat necrosis, and fibrosis. Reported cases cited clinical presentation ranging from abdominal pain to fever of unknown origin, the majority of which were idiopathic and associated with a benign prognosis. We report the case of a 43-yr-old male who presented with malaise, weight loss, microcytic anemia, and a high erythrocyte sedimentation rate. Radiographic and histological investigations revealed typical features of mesenteric panniculitis. Initial treatment with high-dose oral prednisolone led to rapid and complete resolution of symptomatology, radiographic, and laboratory anomalies. Within 6 months, the patient presented again with anemia, renal failure, and hypercalcemia. A diagnosis of IgA kappa chain myeloma was made. Despite chemotherapy and restoration of normocalcemia, he died from refractory pulmonary edema. This is the first report of a hematological malignancy initially presenting with features of mesenteric panniculitis culminating in an aggressive course and a fatal outcome.
Collapse
Affiliation(s)
- J Goh
- Department of Gastroenterology, Mater Misericordiae Hospital and University College, Dublin, Ireland
| | | | | | | | | | | |
Collapse
|
43
|
Poniachik J, Smok G. [Retractile mesenteritis. Report of 4 cases]. Rev Med Chil 2000; 128:1250-4. [PMID: 11347513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Retractile mesenteritis is a rare condition in which the inflammation process of the mesentery is the characteristic pathological. The histologic changes are variable proportions of fat necrosis, chronic inflammation and fibrosis. The clinical presentation of this process is diverse, also the natural history is variable, ranging from a benign to fatal disease. We reviewed 4 cases of retractile mesenteritis and evaluated the clinical manifestations. There was no gender predominance. The patients aged range was 63-69 years (average 65) Patients more often presented with abdominal mass (cases n: 1 and n: 4), and chronic diarrhea (cases n: 1 and 3). The etiology is unknown, the treatment is empirical, including corticosteroids, colchicine, immunosuppressive drugs and oral progesterone.
Collapse
Affiliation(s)
- J Poniachik
- Centro de Gastroenterología e Instituto de Anatomía Patológica, Hospital Clínico Universidad de Chile.
| | | |
Collapse
|
44
|
Papadaki HA, Kouroumalis EA, Stefanaki K, Roussomoustakaki M, Daskalogiannaki ME, Reppa D, Eliopoulos GD. Retractile mesenteritis presenting as fever of unknown origin and autoimmune haemolytic anaemia. Digestion 2000; 61:145-8. [PMID: 10705180 DOI: 10.1159/000007748] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Retractile mesenteritis is an extremely rare disease characterised by a non-specific inflammatory and fibrotic process of the mesenteric adipose tissue, which is usually accompanied by pain and a variety of other abdominal symptoms. We describe here the case of a patient with retractile mesenteritis presenting with prolonged high-grade fever and autoimmune haemolytic anaemia without abdominal symptoms. The patient's illness was complicated by chylous ascites. Diagnosis was suspected by computed tomography and confirmed histologically following exploratory laparotomy. The patient was treated with prednisone and azathioprine, and he had a rapid improvement in anaemia and fever relief, but no substantial change in the mesenteric lesions. Our case adds autoimmune haemolytic anaemia to the wide spectrum of manifestations of retractile mesenteritis and implies the possible involvement of immune mechanisms in the pathogenesis of the disease.
Collapse
MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Azathioprine/administration & dosage
- Biopsy, Needle
- Drug Therapy, Combination
- Fever of Unknown Origin/etiology
- Follow-Up Studies
- Humans
- Male
- Panniculitis, Peritoneal/complications
- Panniculitis, Peritoneal/diagnosis
- Panniculitis, Peritoneal/drug therapy
- Panniculitis, Peritoneal/pathology
- Prednisone/administration & dosage
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- H A Papadaki
- Department of Haematology, University of Crete School of Medicine, University Hospital of Heraklion, Greece
| | | | | | | | | | | | | |
Collapse
|
45
|
Mysorekar VV, Dandekar CP, Rao SG. Mesenteric panniculitis presenting as a huge retroperitoneal mass--a case report. Indian J Med Sci 2000; 54:95-7. [PMID: 11227619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
A rare case of mesenteric panniculitis occurring in a young patient and presenting as a huge retroperitoneal mass which was mistaken for malignancy, has been described.
Collapse
Affiliation(s)
- V V Mysorekar
- Pathology Dept, MS Ramaiah Medical College, Bangalore 560 054
| | | | | |
Collapse
|
46
|
Holzberger P, Türtscher M, Stoss F. [Retractile mesenteritis after resection of Meckel's diverticulum]. Dtsch Med Wochenschr 2000; 125:182-5. [PMID: 10719392 DOI: 10.1055/s-2007-1024016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 22-year-old man who had never been seriously ill previously was admitted because of epigastric pain and vomiting of bile. INVESTIGATIONS He had slight pain on pressure over the epigatric region and decreased intestinal peristaltic sounds. There was evidence of ileus of the small intestine both by ultrasound and radiologically. TREATMENT AND COURSE As the patient's condition deteriorated on conservative treatment, an exploratory laparotomy was performed. It revealed an invaginated Meckel's diverticulum, Ileus of the small intestine recurred postoperatively, requiring relaparotomy. A glued-together volvulus of the small intestine had to be resected, even though there was no sign of an anastomotic leak. But there was no postoperative improvement. A third operation revealed a clearly shortened and 3 cm-thick mesentery which showed a stage III retractile mesenteritis. Histological re-examination of the specimens resected at the previous operations revealed stage I and II retractile mesenteritis. The patient's condition slowly improved on high doses of corticosteroids and he ultimately became symptom-free. CONCLUSIONS Retractile mesenteritis is a very rare benign disease of the mesentery, almost always causing abdominal pain and diagnosed histologically by exploratory laparotomy. Administration of corticosteroids is the treatment of choice.
Collapse
Affiliation(s)
- P Holzberger
- Universitätsklinik für Chirurgie, Universität Innsbruck
| | | | | |
Collapse
|
47
|
Patel N, Saleeb SF, Teplick SK. General case of the day. Mesenteric panniculitis with extensive inflammatory involvement of the peritoneum and intraperitoneal structures. Radiographics 1999; 19:1083-5. [PMID: 10464811 DOI: 10.1148/radiographics.19.4.g99jl221083] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- N Patel
- Department of Radiology, University of South Alabama College of Medicine, Mobile 36617, USA
| | | | | |
Collapse
|
48
|
Kiazand A, Zeboudj N, Valenza B, Garnier T, Bogain CB, Foullon P. [Mesenteric panniculitis. Report of a case]. Presse Med 1999; 28:1113. [PMID: 10399502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
|
49
|
Muñoz-Juárez M, Luque-de León E, Moreno-Paquentin E, Young-Fadok T. [Sclerosing mesenteritis: a disease of malignant appearance]. Rev Gastroenterol Mex 1998; 63:224-30. [PMID: 10319674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Sclerosing mesenteritis is a rare benign disorder of unknown etiology that often resembles a neoplasm. Numerous terms have been used in the past to describe this entity which has a variable clinical presentation and is characterized by thickening of the intestinal mesentery. Accurate information regarding the epidemiology, natural course and therapeutic response of the disease is sparse. Herein we present a review of the literature and a brief discussion of relevant concepts for the diagnosis and treatment of patients with sclerosing mesenteritis.
Collapse
Affiliation(s)
- M Muñoz-Juárez
- Departamento de Cirugía General, Hospital American British Cowdray, México D.F
| | | | | | | |
Collapse
|
50
|
Affiliation(s)
- P Ondrejka
- Dept. of Surgery, Semmelweis University Medical School, Budapest, Hungary.
| | | | | | | |
Collapse
|