Treatment options for spontaneous and postoperative sclerosing mesenteritis

Abstract

Sclerosing mesenteritis is a rare pathology with only a few described cases in the literature. The etiology is unclear; however, several potential triggers, including abdominal surgery and abdominal trauma, have been discussed. The pathology includes a benign acute or chronic inflammatory process affecting the adipose tissue of the mesenterium. Despite it being a rare disease, sclerosing mesenteritis is an important differential diagnosis in patients after abdominal surgery or patients presenting spontaneously with signs of acute inflammation and abdominal pain. We present here three cases with sclerosing mesenteritis. In two cases, sclerosing mesenteritis occurred postoperatively after abdominal surgery. One patient was treated because of abdominal pain and specific radiological signs revealing spontaneous manifestation of sclerosing mesenteritis. So far there are no distinct treatment algorithms, so the patients were treated differently, including steroids, antibiotics and watchful waiting. In addition, we reviewed the current literature on treatment options for this rare disease.

The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common)

“…Because sclerosing mesenteritis is an inflammatory disease of unknown origin, treatment is based on immunosuppressive agents, including glucocorticoids [ 3 , 4 ].…”

“…In the majority of cases, sclerosing mesenteritis is a self-limited disease, which is why asymptomatic cases are left untreated. In patients that present symptoms, therapeutic options include immunosuppressive agents and surgery [ 3 , 4 ].…”

Mesenteric panniculitis in a patient with new onset dermatomyositis

“…In the 92 patients at Mayo Clinic with SM, approximately 50% of cases received some form of treatment 9. For symptomatic patients, multiple treatment modalities have been explored including surgery and medical therapy with steroids, immune modulators, anti-inflammatories, hormonal and antifibrotic agents 8 9 21. Our patient received therapy targeted at her DM with both steroids and mycophenolate mofetil with improvement in her symptoms of DM.…”

Sclerosing mesenteritis:an uncommon cause of chronic abdominal pain

“…Surgical resection is recommendation for non-resolving cases and complicated by bowel obstruction. 1,25 Sharma et al reported that out of 192 cases, 41.7% of cases received surgical resection, 34.9% underwent medical treatment and 17.2% cases were conservatively managed. Of those who received medical 83.5% got steroids and 11.9% received colchicine, tamoxifen and 6-mercaptopurine each.…”