S2658 Symptomatic Sclerosing Mesenteritis: A Flank Problem

Abstract

Introduction: Sclerosing mesenteritis is a rare diagnosis consisting of fatty inflammation and necrosis of the abdominal mesentery. Patients usually present asymptomatically or with vague, generalized systemic symptoms including abdominal pain, fever, and weight loss. Here, we present a case of a 72-year-old female with an unusual presentation of right flank pain in the diagnosis of sclerosing mesenteritis. Case Description/Methods: A 72 YO female was evaluated in the hospital for acute onset, intermittent right flank pain described as a spasm sensation. Her history was significant for multiple abdominopelvic surgeries, dating back almost 50 years and including appendectomy, herniorrhaphy, pelvic reconstruction and hysterectomy, and bladder sling placement. Her most recent surgery was the appendectomy 5 months prior to admission. There was no temporal or positional association of the pain. She had no associated fevers, malaise, changes in bowel habits, nausea, vomiting, melena, or hematochezia. Prior colonoscopy history was unknown. Physical exam showed a diffusely soft, n abdomen without any masses or organomegaly. Laboratory evaluation demonstrated leukocytosis and elevated ESR and CRP. The remaining laboratory work-up was within normal limits. CT abdomen and pelvis without contrast showed hazy attenuation of the mesenteric root with hypodense halos surrounding the mesenteric lymph nodes, suggestive of sclerosing mesenteritis. Surgical intervention was deferred given the patient's comorbid conditions. Given her presentation of flank pain, retroperitoneal ultrasonography was done which was negative for any acute pathologies. Discussion: The diagnosis of sclerosing mesenteritis is often an incidental finding on abdominal imaging, as seen in our patient case. Usually, such imaging studies are performed for evaluation of an abdominal mass seen in up to 35-50% of patients, however, in our case, it was performed for initial evaluation of her flank pain. In our patient case, the only risk factor for the development of sclerosing mesenteritis was her significant history of abdominal surgery. Studies have shown up to 30% of patients diagnosed with sclerosing mesenteritis have a history of prior abdominal surgery. A wide differential should be maintained in patients presenting without obvious abdominal complaints yet having a significant abdominal surgery history.