Sclerosing Mesenteritis: Multidisciplinary Collaboration Is Essential for Diagnosis and Treatment

Abstract

Sclerosing mesenteritis (SM) is an extremely rare disease characterized by chronic non-specific inflammation, fat necrosis and fibrosis of the mesentery. We presented a 77-year-old man with progressive dyschezia, abdominal pain and mass in left lower quadrant. Computed tomography (CT) exhibited a thickened mesentery, enlarged lymph nodes and strand-like densities around the mesenteric vessels. However, laboratory investigation, colonoscopy and positron emission tomography did not provide any specific results for diagnosis. Because of the exacerbating abdominal pain, partial colectomy was performed and SM was diagnosed based on the pathological changes of mesentery including fat necrosis, multifocal lipid-filled macrophages, lymphocytes and multifocal fibrosis. Although SM is difficult to diagnose and often found by incident, progressive deterioration of abdominal symptoms and general status alteration are indicators of SM. Some typical imaging and pathologic manifestations are also helpful to SM diagnosis. There is no standard treatment for SM. Operation is preferred in those at the stage of fibrosis and particularly combined with intestinal obstruction. Therefore, a multidisciplinary collaboration is essential to diagnose and manage this rare disease, with combined approaches in gastroenterology, colorectal surgery, pathology and radiology.

Sclerosing mesenteritis:an uncommon cause of chronic abdominal pain

“…5 Sclerosing Mesenteritis is characterized by fat degeneration, necrosis, chronic inflammation, scarring and eventually fibrosis of the fatty tissue within the mesentery. 7 The most commonly affected are the mesentery of the small bowel and the mesoappendix even though the large bowel mesentery is less commonly affected. 8 The exact mechanism is unknown; however, several conditions have been associated with SM.…”

“…Other symptoms included weight loss, diarrhea, vomiting, anorexia, constipation, bloating, malaise, nausea, pain with eating and fatigue. 6 He H et al, 7 reported a 77years old male who presented with dyschezia, abdominal pain and mass in left lower quadrant and Katsuya Endo et all reported a 22years old Japanese male who presented with chronic abdominal pain and small intestine mesentery mass. 7,21 Harvin G reported a case of SM who presented with intestinal obstruction.…”

“…6 He H et al, 7 reported a 77years old male who presented with dyschezia, abdominal pain and mass in left lower quadrant and Katsuya Endo et all reported a 22years old Japanese male who presented with chronic abdominal pain and small intestine mesentery mass. 7,21 Harvin G reported a case of SM who presented with intestinal obstruction. 22 On physical examination majority of the patients have a normal abdominal exam however others may elicit abdominal tenderness, abdominal mass and ascites based on the underlying cause.…”

“…The laboratory findings of SM are non-specific. 7 Majority of the patients have elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The study by Sharma et all showed that 86.5% of patients had elevated CRP and 88.4% of the cases had elevated ESR.…”

Sclerosing mesenteritis mimicking metachronous peritoneal metastases from descending colon adenocarcinoma

“…Sclerosing mesenteritis is non-specific inflammatory mass-forming lesion in the mesenteric connective tissue that is characterized by variable degrees of fibrosis, chronic inflammation, and fat necrosis [ 1 – 5 ] and mainly affects the mesentery of the small bowel [ 2 – 9 ]. Although the exact etiology of sclerosing mesenteritis has not been elucidated [ 1 – 6 , 9 – 14 ], it has been reported that the possible risk factors for the disease include malignancy, autoimmune disease, infection, ischemia, trauma, and a history of previous surgery [ 3 , 5 , 8 , 11 , 12 ]. Sclerosing mesenteritis is sometimes indistinguishable from neoplasms because its manifestations and radiographic findings may be identical to those of malignancies [ 3 , 6 , 7 ].…”