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Intestinal obstruction, progressive weight loss, and recurrent fever in two patients with mesenteric lesions
J C Hoffmann1, R Lamberts, P Huppert
1Department of Gastroenterology and Hepatology, Eberhard Karls University, Tübingen, Germany. 101504.3210@compuserve.com
Abstract:
We describe 2 patients who presented with fever and incomplete intestinal obstruction. Previously, both patients had had laparotomies showing unresectable lesions in the root of the mesentery which were histologically diagnosed as sclerosing mesenteritis in the first and mesenteric fibromatosis in the second patient. In spite of aggressive immunosuppressive therapy the first patient deteriorated with high-grade fever and progressive weight loss. Similar symptoms occurred in the second patient. Computed tomographic scanning revealed necrotic lesions in both patients which histologically were found to be an angiocentric T-cell lymphoma in the first and a superinfected necrotizing fibroma in the second patient. It is therefore clinically and radiologically impossible to distinguish between the different causes of mesenteric lesions. Reoperation for further biopsies needs to be considered if such patients do not respond to medical treatment.
Insights
Diagnosing mesenteric lesions is challenging, as initial treatments for sclerosing mesenteritis and mesenteric fibromatosis can mask underlying conditions like T-cell lymphoma or necrotizing fibroma.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Mesenteric lesions, including sclerosing mesenteritis and mesenteric fibromatosis, can present with symptoms like fever and intestinal obstruction.
- Distinguishing between these conditions and aggressive pathologies can be difficult based on initial presentation.
Observation:
- Two patients with previously diagnosed mesenteric lesions (sclerosing mesenteritis, mesenteric fibromatosis) presented with fever and worsening symptoms despite immunosuppressive therapy.
- Computed tomography revealed necrotic lesions, which upon biopsy, were identified as angiocentric T-cell lymphoma and superinfected necrotizing fibroma.
Findings:
- Clinical and radiological features of various mesenteric lesions can be indistinguishable.
- Aggressive pathologies like T-cell lymphoma can arise in the context of initially benign-appearing mesenteric conditions.
Implications:
- Rethinking diagnostic approaches for complex mesenteric lesions is crucial.
- Reoperation for biopsy may be necessary for patients with refractory symptoms to identify underlying malignant or aggressive conditions.
- Early and accurate diagnosis of mesenteric lesions is vital for effective treatment and improved patient outcomes.