Sclerosing mesenteritis presenting with small bowel obstruction and subsequent retroperitoneal fibrosis

Abstract

Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery of unknown aetiology. It poses a diagnostic challenge for clinicians, as it can be mistaken for malignancy. We report a case of sclerosing mesenteritis initially presented with abdominal pain, tender abdominal mass and small bowel obstruction. Emergency laparotomy revealed fibrous thickening of the small bowel mesentery mimicking small bowel lymphoma. An ileo-ileal bypass procedure was performed. Six months later, the patient developed retroperitoneal fibrosis, manifesting as bilateral obstructive uropathy. Our case is unique, as it describes retroperitoneal fibrosis developing in a patient with small bowel retractile mesenteritis, with no evidence of colonic or other anatomical involvement. Furthermore, the patient had no risk factors for this condition. We conclude that the presence of sclerosing mesenteritis should cue clinicians to search for other coexisting inflammatory disorders that can have serious sequelae.

Sclerosing mesenteritis: update on diagnostic and therapeutic approach

“…26,[27][28][29][30][31] Some investigators report spontaneous resolution of disease, and others describe the curative resection and laparotomy is clearly indicated in the case of sclerosing mesenteritis, associated bowel obstruction nonresolving. 12,[29][30][31][32][33] In the absence of spontaneous resolution, several different therapeutic approaches have found some measure of success; although in the therapies are uniformly efficacious. 34 The clinical management depends on the histological findings and stage of the disease.…”

Sclerosing mesenteritis as a rare cause of upper abdominal pain and digestive disorders

“…In addition, possible causative factors have been suggested, including infection, previous trauma or surgery, ischemia, or autoimmune disorders (1). Men are twice as frequently affected as women, and the mean age of disease presentation is the fifth or sixth decade (1).…”

Sclerosing mesenteritis as a rare cause of abdominal pain and intraabdominal mass: a cases report and review of the literature

“…So their clinical manifestation can vary. Patients may present with abdominal pain, intestinal obstruction, fever, chylous ascites, a mass, constipation or diarrhea [4,5]. Because its clinical manifestations are nonspecial and atypical, so the preoperative diagnosis of sclerosing mesenteritis can be very difficult [6].…”