Images - Sclerosing mesenteritis presenting with unilateral hydro-ureteronephrosis.

Abstract

Sclerosing mesenteritis (SM) is a rare benign condition that can have many different presentations, including abdominal pain, gastrointestinal symptoms, weight loss, or fever.1 The pathogenesis of this disease is not well-understood, but it may share a common etiology with other idiopathic primary inflammatory and fibrotic processes, such as mesenteric lipodystrophy (adipocyte necrosis) and mesenteric panniculitis (chronic inflammatory state).1 The reported prevalence is 0.6–2.5%, with a male to female ratio of 2 :1.1–4 The non-specific presentation can make the clinical diagnosis difficult. Abdominal exam can identify a mass in less than 50% of cases, while C-reactive protein (CRP) and erythrocytes sedimentation can be a way to follow its response to treatment.5,6 Abdominal contrasted enhanced computed tomography (CT) scan is the most sensitive imaging modality with two specific signs: “fat ring sign” and “tumor pseudocapsule.”4,7,8 To complete the diagnosis, a pathological examination is often required. This case report highlights how the non-specific presentation of SM can obscure the diagnosis.