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Updated: Jun 27, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Sclerosing Mesenteritis: A Concise Clinical Review for Clinicians
Bibek Saha1, June Tome2, Xiao Jing Wang2
1Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Abstract:
Sclerosing mesenteritis (SM), an idiopathic nonneoplastic condition affecting 0.18% to 3.14% of the population, is characterized by chronic fat necrosis, inflammation, and fibrosis most commonly of the mesentery of the small intestine. Sclerosing mesenteritis typically presents in the fifth or sixth decade of life, where patients with a history of abdominal surgery and/or autoimmune disease may be at higher risk. While many patients are asymptomatic, clinical features and complications are related to the mass effect resulting from the inflammation and fibrosis involved in the pathogenesis of SM. When present, common signs, symptoms, and complications include abdominal pain, weight loss, diarrhea, palpable abdominal mass on examination, bowel obstruction, chylous ascites, and mesenteric vessel thrombosis. Although SM was historically diagnosed predominantly by biopsy, current practice has shifted away from this to computed tomography imaging of the abdomen, given the invasive nature of biopsy. However, certain conditions, including mesenteric neoplasia (lymphoma, metastatic carcinoid tumor, desmoid tumor, mesenteric carcinomatosis), can mimic SM on imaging, and if clinical suspicion is equivocal, a biopsy may be warranted for definitive diagnosis. Asymptomatic patients do not require treatment. For patients with pronounced symptoms or complicated SM, the combination of tamoxifen 10 mg twice daily and prednisone 40 mg daily is the first-line pharmacotherapy; no randomized controlled trial of this regimen has been performed. Rarely, surgery may be necessary in cases of persistent bowel obstruction refractory to medical management. Sclerosing mesenteritis has an overall benign course in most cases, but disease progression and fatal outcomes have been reported.
Insights
Sclerosing mesenteritis (SM) is a rare condition causing abdominal issues due to inflammation and fibrosis. Diagnosis often uses CT scans, with tamoxifen and prednisone as primary treatments for symptomatic cases.
Area of Science:
- Gastroenterology
- Abdominal Imaging
- Pathology
Background:
- Sclerosing mesenteritis (SM) is an idiopathic, non-neoplastic condition characterized by chronic inflammation, fibrosis, and fat necrosis, primarily affecting the small intestine's mesentery.
- It typically presents in the fifth or sixth decade, with potential risk factors including prior abdominal surgery and autoimmune diseases.
- While often asymptomatic, SM can manifest with abdominal pain, weight loss, diarrhea, and complications like bowel obstruction and mesenteric vessel thrombosis.
Purpose of the Study:
- To provide a comprehensive overview of sclerosing mesenteritis (SM), covering its epidemiology, clinical presentation, diagnostic approaches, and management strategies.
- To highlight the shift in diagnostic practices from biopsy to computed tomography (CT) imaging for SM.
- To discuss the differential diagnoses, treatment options, and prognosis of SM.
Main Methods:
- Review of existing literature on sclerosing mesenteritis (SM).
- Analysis of diagnostic modalities, emphasizing the role of computed tomography (CT) imaging.
- Evaluation of current pharmacotherapy and surgical interventions for symptomatic or complicated SM.
Main Results:
- Sclerosing mesenteritis (SM) affects 0.18% to 3.14% of the population, with diagnosis shifting towards CT imaging over biopsy.
- Common symptoms include abdominal pain, weight loss, and diarrhea; complications involve bowel obstruction and mesenteric thrombosis.
- First-line treatment for symptomatic SM involves tamoxifen and prednisone, though no randomized controlled trials support this regimen.
Conclusions:
- Sclerosing mesenteritis (SM) is a rare condition with varied presentations, often diagnosed via CT imaging.
- While generally benign, SM can progress and lead to fatal outcomes in some cases.
- Management focuses on symptomatic relief and preventing complications, with tamoxifen and prednisone as the current standard pharmacotherapy.
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