Sclerosing mesenteritis presenting with complete small bowel obstruction, abdominal mass and hydronephrosis

Hassan, Tuyyab; Balsitis, M; Rawlings, David J.; Shah, AA

doi:10.1007/s11845-010-0495-1

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…8). Calcification may be seen within the soft-tissue mass, most likely reflecting a sequela of fat necrosis, and there may be encasement of the adjacent bowel loops and vascular structures, leading to signs of obstruction and occasionally to hollow visceral ischemia [13,22].…”

Section: Imaging Findings In Retractile Mesenteritismentioning

confidence: 99%

The “Misty Mesentery”: Mesenteric Panniculitis and Its Mimics

McLaughlin

Filippone

Maher

2013

American Journal of Roentgenology

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ing features of MP and of a wider spectrum of related disorders belonging to the parent group sclerosing mesenteritis. A misty mesentery can be seen in association with a range of pathologic entities other than MP. Imaging findings in conditions known to mimic MP are also described in an attempt to provide the radiologist with a basis for rational differential diagnosis. Pathophysiology MP belongs to a continuum of idiopathic disorders of the mesentery and peritoneum referred to as "sclerosing mesenteritis" [4]. Pathologically, sclerosing mesenteritis can be divided into three stages. The first stage is mesenteric lipodystrophy in which a layer of foamy macrophages replaces the mesenteric fat [4]. The second stage is MP in which there is an infiltrate of plasma cells, polymorphonuclear leukocytes, and foamy macrophages [4, 5]. The final stage is retractile mesenteritis, which is characterized by collagen deposition, fat necrosis, and fibrosis that leads to tissue retraction [4, 5]. The cause of sclerosing mesenteritis remains unclear, although several possible causes have been proposed in the literature including previous abdominal surgery, abdominal trauma, autoimmunity, vasculitis, and infection [6]. Sclerosing mesenteritis has been associated in a number of case studies with a variety of intraabdominal and extraabdominal malignant diseases including lymphoma, colorectal carcinoma, gastric carcinoma, renal cell carcinoma, melanoma, myeloma, chronic lymphocytic leukemia, and carcinoid tumors [6]. Currently, there is no clear answer to the question of how strongly sclerosing mesenteritis is associated with underlying malignancy. Kipfer et al. [7] reported that 30% of patients with sclerosing mesenteritis had an underlying malignancy, whereas Daskalogiannaki et al. [6] reported a higher rate of 69% of sclerosing mesenteritis patients with coexisting malignancy. Other investigators have found that

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Section: Imaging Findings In Retractile Mesenteritismentioning

confidence: 99%

The “Misty Mesentery”: Mesenteric Panniculitis and Its Mimics

McLaughlin

Filippone

Maher

2013

American Journal of Roentgenology

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“…Ein enteropathischer Proteinverlust mit letalem Ausgang wurde beschrieben [20]. Möglich sind aber auch palpable Massen, welche zur Obstruktion des Dünndarms führen und eine Harnstauung verursachen [21]. Differenzialdiagnostisch sollte daher bei mesenterialen und retroperitonealen Tumoren an diese Entität gedacht werden [22].…”

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Enteroskopie und Bildgebung bei sklerosierender Mesenteritis

Gottschalk¹,

Nitzsche²,

Felber

et al. 2012

Z Gastroenterol

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Sclerosing mesenteritis is a rare, benign, and chronic fibrosing inflammatory disease of the mesenteric fatty tissue. Its aetiology is unknown. In the present report we describe a 56-year-old women who presented with postprandial abdominal pain, and weight loss. Ultrasound, computed tomography, and magnetic resonance imaging revealed a mesenteric mass of 15 cm. The findings were typical for this disease. Additionally the patient underwent a single ballon enteroscopy in which the mucosa showed a considerable hyperergic reaction. The histological examination of the ileum was appropriate to support the suspicion. The patient's symptoms responded to a therapy with tamoxifen.

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IgG4-related sclerosing mesenteritis causing bowel obstruction: a case report

et al. 2016

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Sclerosing mesenteritis (SM) is a rare inflammatory and fibrosing disease primarily involving the small-bowel mesentery. Recently, SM was reported to be closely related to IgG4-related disease (IgG4-RD). This report describes a patient with SM associated with IgG4-RD. A 77-year-old woman with a history of surgery for ectopic pregnancy and wound dehiscence presented with intestinal obstruction. Abdominal enhanced computed tomography (CT) revealed an enhanced, radially shaped, oval mass, 3 cm in diameter, with an unclear rim in the mesentery of the distal ileum, which may have involved the distal ileum. To remove the cause of bowel obstruction, the SM was resected completely and the ileum was resected partially. Histologic examination showed that the mass was composed of spindle cells arranged in a fascicular or storiform pattern; moreover, fibrous stroma was observed, with dense lymphoplasmacytic infiltration and lymphoid follicles. Immunohistochemically, numerous IgG4-positive plasma cells were observed, at a density of 253 per high-powered field, and the IgG4/IgG ratio was about 50 %. Elastica van Gieson (EVG) staining also showed obstructive phlebitis. These findings indicated IgG4-related SM. Although the accurate diagnosis of SM remains difficult without histological analysis, IgG4-RD should be included in the differential diagnosis of unknown mesenteric tumors. Identification of IgG4-RD may prevent unnecessary surgery because corticosteroids may be effective in these patients.

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Sclerosing mesenteritis presenting with complete small bowel obstruction, abdominal mass and hydronephrosis

Cited by 4 publications

References 8 publications

The “Misty Mesentery”: Mesenteric Panniculitis and Its Mimics

The “Misty Mesentery”: Mesenteric Panniculitis and Its Mimics

Enteroskopie und Bildgebung bei sklerosierender Mesenteritis

IgG4-related sclerosing mesenteritis causing bowel obstruction: a case report

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