Refractory Sclerosing Mesenteritis Involving the Small Intestinal Mesentery: A Case Report and Literature Review

Objective: The aim of this study was to determine the prevalence of mesenteric panniculitis (MP) and to describe its clinical characteristics, therapy, and outcome. Subjects and Methods: This retrospective study was carried out among patients with MP based on computed tomography (CT) scans from January 2012 to December 2015. The CT images were reanalyzed by study radiologists to confirm the previous MP diagnosis. Patients were divided into 2 groups, i.e., idiopathicandsecondary, based on the presence or absence of associated predisposing factors such as trauma, malignancy, autoimmune disorders, ischemia, or previous abdominal surgery. The clinical characteristics of the 2 groups, as well as treatments, were assessed. Results: Among the 19,869 CT scans, 36 patients (0.18%) with MP were identified (i.e., 19 [53%] females and 17 [47%] males). The median age was 54 years (range 26 - 76). Twenty-four patients (67%) were categorized into the idiopathic group. Malignancy was the predisposing factor in 8 (22%) of those patients. Furthermore, abdominal pain was the cardinal symptom observed in 22 patients (92%) in the idiopathic group. In the idiopathic group, 15 patients (63%) were treated with antibiotics and 16 (67%) were treated with nonsteroidal anti-inflammatory drugs (NSAID). One unresponsive patient was treated with colchicine. Symptomatic relief was achieved in all of the treated patients. Conclusion: In thisstudy, a symptomatic idiopathic subgroup of patients with MP did not have any associated disorder. The response to treatment with antibiotics and NSAID was effective in most of the patients. Based on these findings, anti-inflammatory treatments beyond NSAID and surgery should be reserved for patients who are unresponsive to antibiotics and NSAID.

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“…However, the previous therapeutic interventions have shown varying degrees of success. Surgery is another option in refractory cases [12,13].…”

Section: Introductionmentioning

confidence: 99%

An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis

Şahin¹,

Artaş

Eroğlu

et al. 2017

Med Princ Pract

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“…For example, if a long segment of the jejunum would have needed to be removed in the patient with small bowel mesentery of the jejunum which was shown to be widely involved on the CT scan and gross findings during laparotomy, such an operation could, with high probability, result in short bowel syndrome. 44 Although there is uncertainty about the optimal treatment, it is a situation with a favorable prognosis in most patients with good responses to treatment. 6 …”

Section: Discussionmentioning

confidence: 99%

Sclerosing mesenteritis: update on diagnostic and therapeutic approach

et al. 2016

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“…The rate of recurrence is rare. However, 20% of patients have significant morbidity and a chronic debilitating course [5,6,45].…”

Section: Prognosismentioning

confidence: 99%

“…A minority of patients have rapid and fatal evolution, and according to some authors, a reasonable percentage developed malignancies during the studies, including lymphoma, carcinoid syndrome, lung adenocarcinoma and mesothelioma [6,45].…”

Section: Prognosismentioning

confidence: 99%

Sclerosing Mesenteritis-Update on Diagnostic and Therapeutic Approach

Garcia¹,

Oliveira²

2016

Transl Biomed

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The sclerosing mesenteritis (SM) is a rare, non-specific inflammatory condition, mainly affecting the benign intestinal mesentery. It is known that she is diagnosed mainly during the sixth and seventh decade of life and seems to be two times more common in men than in women. The etiology of SM remains unknown, although several mechanisms have been suggested contributors, including surgery or abdominal trauma before, autoimmunity, paraneoplastic syndrome, ischemic injury and infections. The major signs and symptoms are abdominal pain, presence of palpable abdominal mass, nausea and vomiting, bowel changes, weight loss, small bowel obstruction, chylous ascites and peritoneal irritation signals. About of 10% of the patients are asymptomatic. The radiological study, especially computed tomography (CT) and magnetic resonance imaging (MRI) are essential components in the diagnostic evaluation. The ''greasy'' ring signal and the pseudocapsule tomographic findings are considered specific tumoral this pathology. The diagnosis is established by histopathologic study. There is no specific treatment for SM and should this be empirical and individualized. Although they are described cases of spontaneous remission, some authors have shown benefit with the empirical treatment using corticosteroids, colchicine, immunosuppressants, antibiotics, tamoxifen, alone or in combination. The surgical approach has a limited role and usually aimed at symptomatic relief. In most cases, the prognosis is favorable.

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Refractory Sclerosing Mesenteritis Involving the Small Intestinal Mesentery: A Case Report and Literature Review

Cited by 22 publications

References 45 publications

An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis

An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis

Sclerosing mesenteritis: update on diagnostic and therapeutic approach

Sclerosing Mesenteritis-Update on Diagnostic and Therapeutic Approach

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