SCLEROSING MESENTERITIS – A CASE REPORT

Case Presentation A 50-year-old male was admitted with abdominal pain, vomiting, and cessation of bowel movements for 2 days. He was previously healthy and denied alcohol consumption, smoking, or medication use. His medical history included an appendectomy 37 years ago, two laparotomies for intestinal obstruction, and other episodes of subocclusion treated clinically. Upon examination, his abdomen was distended, painful, and hyperresonant. Laboratory tests were normal. A CT scan suggested mechanical intestinal obstruction, and conservative treatment was initiated but was unsuccessful. A laparotomy was performed with the release of firm adhesions, and he was discharged on the 5th day. He returned 48 hours later with subocclusion and a palpable mass on the left. A new CT scan showed diffuse distension, mesenteric fat densification, deviation, and ectasia of some vessels. A second surgery was performed with adhesion release, peritoneostomy, and biopsies of the mesentery, confirming sclerosing mesenteritis (SM). The patient was started on total parenteral nutrition (TPN), prednisone, and tamoxifen, which were maintained for 60 days postoperatively. At that point, the abdomen became flaccid, allowing for closure, and the patient was discharged.

Discussion Sclerosing mesenteritis (SM) is a condition affecting the mesentery, characterized by necrosis, chronic inflammatory infiltration, and fibrosis. Its etiology is not well established, but it may have an autoimmune origin or be associated with abdominal surgeries and neoplasms. Lipodystrophy and panniculitis are considered early and intermediate stages, while mesenteritis is the advanced stage, marked by fibrosis and vascular ectasia. It is more common in men over 50 years old. Symptoms are nonspecific, including recurrent abdominal pain, anorexia, weight loss, changes in bowel habits, and fever, with some patients presenting normal physical exams. In advanced stages, a fixed, painful abdominal mass with ill-defined borders and firm consistency occurs due to the entrapment of bowel loops and retraction of the mesentery, which may lead to obstruction, chylous ascites, and thrombosis. CT scans show a heterogeneous expanding mass with fat density, ectatic vessels, fibrotic retraction of the mesentery, and pseudocapsular tumor-like structures delimiting affected and unaffected parts. The diagnosis is presumptive and confirmed by histopathology. Although there is no consensus, prednisone, tamoxifen, azathioprine, or colchicine, alone or in combination, appear to provide good responses.

Conclusion Sclerosing mesenteritis is a rare disease with an uncertain etiology and difficult diagnosis for clinicians, surgeons, radiologists, and pathologists. Its treatment is primarily conservative, and surgical intervention is indicated for cases of intestinal obstruction without satisfactory resolution or when malignancy is suspected in the affected mesenteric area.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025