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.

Keywords: Abdominal pain; Immunosuppression; Inflammation; Sclerosing mesenteritis; Surgery.

Figure 1

Transverse abdominal computed tomography scan with a tumor mass (15 cm × 8.8 cm × 7.8 cm, white arrow) in the upper left hemiabdomen. The mass shows increased density in comparison to normal fat and a tumoral pseudocapsule.

Figure 2

Sagittal abdominal computed tomography scan with an unclear mass in the omental fat with obstruction of the small intestine (white arrow).

Figure 3

Transverse abdominal computed tomography scan as the gold standard with an inflammation of the mesenterium at the height of the navel.

Figure 4

Transverse abdominal computed tomography scan shows a nonspecific inflammatory process involving the adipose tissue of the small bowel mesentery.

Figure 5

Inflammation of the small bowel adipose tissue formed as a pseudotumor in the left abdomen in the transverse abdominal computed tomography (white arrow).

Figure 6

Signs of sclerosing mesenteritis with lymphadenopathy in the lower left abdomen in the transverse abdominal computed tomography (white arrow).