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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Sclerosing Mesenteritis Presenting as Intestinal Occlusion: A Case Report
Miguel E Rodrigues1, João Luís Pinheiro1, Bruno Barbosa1
1General Surgery, Unidade Local de Saúde (ULS) de Viseu Dão-Lafões, Viseu, PRT.
Abstract:
Sclerosing mesenteritis is a chronic disease that primarily affects the mesenteric adipose tissue and encompasses a range of fibrotic and inflammatory pathologies. Due to its low incidence, the etiology remains unclear, though various factors are thought to contribute to its onset. Clinical manifestations are nonspecific, ranging from asymptomatic cases to persistent abdominal pain, which is the most common symptom. Incidental findings on imaging have increased with the widespread use of computed tomography (CT) scans. However, the diagnosis remains histological. Sclerosing mesenteritis is mainly associated with a good prognosis, as it typically follows a benign clinical course and rarely presents with complications or persistent symptoms. In this article, the authors present a clinical case of an 82-year-old male patient who presented with abdominal pain, constipation, and vomiting. The patient underwent an urgent laparotomy for intestinal occlusion. Histological examination confirmed sclerosing mesenteritis. Due to its limited understanding, sclerosing mesenteritis is often misdiagnosed. It should be considered as a differential diagnosis, particularly in patients with poorly defined abdominal pain, normal laboratory studies, and nonspecific imaging findings, to avoid unnecessary treatments. Nonetheless, urgent surgical intervention may be necessary in cases presenting with intestinal occlusion or uncontrolled pain.
Insights
Sclerosing mesenteritis is a rare fibrotic disease of the mesentery. This case highlights the importance of considering this condition in patients with nonspecific abdominal pain to ensure accurate diagnosis and appropriate management.
Area of Science:
- Gastroenterology and Hepatology
- Abdominal Imaging
- Surgical Pathology
Background:
- Sclerosing mesenteritis is a rare, chronic inflammatory and fibrotic condition affecting the mesenteric adipose tissue.
- Its etiology is largely unknown, contributing to its low incidence and diagnostic challenges.
- Clinical presentation is often nonspecific, with abdominal pain being the most common symptom.
Observation:
- Computed tomography (CT) scans increasingly lead to incidental findings of sclerosing mesenteritis.
- Diagnosis is definitively established through histological examination.
- A case of an 82-year-old male with abdominal pain, constipation, and vomiting requiring laparotomy for intestinal occlusion is presented.
Findings:
- Histological examination confirmed sclerosing mesenteritis in the presented case.
- The condition is frequently misdiagnosed due to its nonspecific symptoms and imaging findings.
- Sclerosing mesenteritis generally has a good prognosis with a benign clinical course.
Implications:
- Sclerosing mesenteritis should be considered in the differential diagnosis for patients with unexplained abdominal pain and non-specific findings.
- Early consideration can prevent misdiagnosis and unnecessary treatments.
- Urgent surgical intervention may be required for complications like intestinal obstruction or intractable pain.
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