Question: A 55-year-old Egyptian woman with a history of migraine, B-cell lymphoma (in remission), and depression was admitted with diffuse abdominal pain after 2 presentations to the emergency department within 1 week with similar complaints. She denied nausea, vomiting, hematochezia or fever. She had been seen in the GI clinic over many years with postprandial epigastric pain and nausea with negative imaging and endoscopic testing and had been diagnosed with functional dyspepsia. Physical examination revealed the patient looked pale and was in distress with mild tenderness to deep palpation in the left upper abdominal quadrant, with no guarding or rebound and a generally soft abdomen. Rectal examination was negative for masses and blood. Laboratory testing was pertinent for a decrease in hemoglobin from 12 to 9 g/dL. Other routine laboratory tests were normal. She underwent computed tomography scanning of the abdomen/pelvis, which revealed intraabdominal hemorrhage in the left upper quadrant around the body and tail of the pancreas, between stomach and spleen with extension to the pararenal space (Figure A). What is the etiology of the patient's intraabdominal hemorrhage? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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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.

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