Weight Loss … Whatʼs Lying Underneath … Sclerosing Mesenteritis

Abstract

Sclerosing mesenteritis is a rare, benign pathological condition characterized by chronic fibrotic inflammation of the adipose tissue of the mesentery of small and large bowel. This condition with unknown etiology, lacks special and specific clinical presentation with typical signs, so easily misdiagnosed. Diagnosis can be challenging and complex, as clinical presentation ranging from asymptomatic to acute abdomen, require appropriate clinical, imaging and histopathological evaluation. A 59 years old man being a non-smoker, presented as outpatient with the history of significant weight loss of 30 Kg in last 3 months with no abdominal pain or discomfort. He had no significant past medical or surgical history with no prior history of medication intake. He underwent complete laboratory evaluation including blood picture, liver profile, thyroid and renal functions, all were normal except for ESR of 44 and stool for occult blood was positive. Esophagoscopy and colonoscopy performed showing gastritis and a polypoidal rectal mass. He then underwent CT scan revealing a rectal mass with a partly calcified soft tissue lesion involving the mesentery of small intestine. Biopsy of rectal mass was inconclusive followed by biopsy of the lymphnodes that again showed features of chronic nonspecific inflammation. Underwent exploratory laparotomy for definitive diagnosis, found to have the hard calcified nodules in the ant.abd wall, ascending colon mesentary, multiple small bowel mesentery and mesentary of transverse colon. no gross ascites, No liver, bowel or kidney involvement. The patient's postoperative course was uneventful. Pathology examination proved to be consistent with sclerosing mesenteritis with dense inflammation and fibrosis with foamy histiocytes and lymphoid aggregates. Prednisolone was started along with methotrexate by the oncologist. Clinically he started to improve and gained weight.As clinically he remained stable rather improved so repeat CT scan was not performed. It is a rare idiopathic inflammatory disorder involving predominantly small bowel mesentery. Diagnosis is a challenge to surgeons, radiologists, gastroenterologists and pathologists. Proper evaluation of the patient regarding their clinical features, imaging and histopathology is required. Overall prognosis is usually good and recurrence seems to be rare. However long-term follow-up is needed to document the results.Figure: SPOKE WHEEL appearance of mesentery.Figure: Enhancing mesentery.Figure: SPOKE WHEEL appearance of mesentery.