Sclerosing Mesenteritis: Clinical Features, Treatment, and Outcome in Ninety-Two Patients

doi:10.1016/j.cgh.2007.02.032

Clinical Gastroenterology and Hepatology

Volume 5, Issue 5, May 2007, Pages 589-596

Presented at Digestive Diseases Week, 2003, Orlando, Florida, Digestive Diseases Week, 2006, Los Angeles, CA, and published in abstract form (Gastroenterology 2003;124(Suppl 1):S1297 and Gastroenterology 2006;130(Suppl 2):M1196).

https://doi.org/10.1016/j.cgh.2007.02.032 Get rights and content

Background & Aims: Sclerosing mesenteritis is a rare non-neoplastic disease that affects the small bowel mesentery with chronic fibrosing inflammation. There are few data on the natural history and therapeutic options for this condition. Methods: We performed a retrospective and prospective study to describe the clinical characteristics, therapy, and outcome of all cases of sclerosing mesenteritis diagnosed at the Mayo Clinic, Rochester, from 1982–2005. Results: Ninety-two cases were identified; 70% were male, with a median age of 65 years (interquartile range, 55–72). Common presenting symptoms included abdominal pain in 70%, diarrhea in 25%, and weight loss in 23%. Treatment included medical therapy alone in 26%, surgery alone in 13%, surgery followed by medical therapy in 9%, and 52% received no treatment. Ten percent responded to surgery alone, 20% responded to additional medical treatment after surgery, and 38% responded to medical therapy alone. Tamoxifen in combination with prednisone was used in 20 patients, and 60% improved. Non-tamoxifen–based regimens were used in 12 patients, and 8% improved. Eighteen deaths were noted during the study period, and 17% were attributed to complications of sclerosing mesenteritis or its treatment. Conclusions: Although a relatively benign condition, sclerosing mesenteritis can have a prolonged debilitating course with a fatal outcome. Our results suggest that symptomatic patients might benefit from medical therapy, particularly tamoxifen and prednisone combination treatment. Long-term follow-up is needed to substantiate these results.

Section snippets

Methods

After approval by the Mayo Clinic’s Institutional Review Board, 65 patients with a diagnosis of SM and its variants were retrospectively identified from January 1982–November 2002 through the Mayo Clinic diagnostic index and Department of Pathology database. An additional 28 cases were prospectively identified as referrals to our gastroenterology outpatient clinic between December 2002–November 2005. One patient denied research authorization and was excluded from the study. All pathology slides

Clinical Presentation and Diagnosis

Ninety-two cases of SM were identified during the study period. Patient characteristics at presentation are shown in Table 1. The most frequent presenting symptoms were abdominal pain in 70%, bloating and distention in 26%, diarrhea in 25%, and weight loss in 23% (Table 2). SM was an incidental finding in 10% of cases when an abdominal surgery (3%), computed tomography (CT) scan (5%), or autopsy (1%) was performed for another indication, and there were no symptoms attributable to mesenteric

Discussion

The current study represents the largest series of patients reported to date with the diagnosis of SM or its variants and, to the best of our knowledge, the most comprehensive information on treatment responses currently available. Other than 2 prior large series including 53 and 84 patients, respectively,1, 3 most published reports are single patients or small case series8, 12, 13, 14 or reviews of existing literature.4, 5, 6, 15 Because of the paucity of published cases, the clinical and

Conclusions

SM is a rare idiopathic disorder that involves the small bowel mesentery with varying degrees of fibrosis, inflammation, and fat necrosis. Its clinical presentation is quite variable and ranges from asymptomatic to debilitating disease. Approximately 50% of the patients might not require any treatment. However, in symptomatic cases, treatment should be tailored according to the severity and type of individual symptoms. Patients with intractable bowel obstruction might require surgery, and those

References (39)

R. Mazure et al.
Successful treatment of retractile mesenteritis with oral progesterone
Gastroenterology
(1998)
K.H. Katsanos et al.
A fatal case of sclerosing mesenteritis
Dig Liver Dis
(2004)
H. Oshiro et al.
Idiopathic retroperitoneal fibrosis associated with immunohematological abnormalities
Am J Med
(2005)
H. Medina-Franco et al.
Concomitant sclerosing mesenteritis and bile duct fibrosis simulating Klatskin’s tumor
J Gastrointest Surg
(2001)
Y. Zen et al.
IgG4-positive plasma cells in inflammatory pseudotumor (plasma cell granuloma) of the lung
Hum Pathol
(2005)
J. MacGregor Schafer et al.
Estrogen receptor alpha mediated induction of the transforming growth factor alpha gene by estradiol and 4-hydroxytamoxifen in MDA-MB-231 breast cancer cells
J Steroid Biochem Mol Biol
(2001)
B.A. Savelli et al.
Successful treatment of sclerosing cervicitis and fibrosing mediastinitis with tamoxifen
Chest
(1997)
J. Few et al.
Riedel’s thyroiditis: treatment with tamoxifen
Surgery
(1996)
Y.J. Jung et al.
A case of Riedel’s thyroiditis treated with tamoxifen: another successful outcome
Endocr Pract
(2004)
T.S. Emory et al.
Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity?
Am J Surg Pathol
(1997)

V. Jura

Sullamesenterite e sclerosante

Policlinico (sezprat)

(1924)

R.E. Kipfer et al.

Mesenteric lipodystrophy

Ann Intern Med

(1974)

A.L. Durst et al.

Mesenteric panniculitis: review of the literature and presentation of cases

Surgery

(1977)

W.W. Ogden et al.

Mesenteric panniculitis: review of 27 cases

Ann Surg

(1965)

J.K. Kelly et al.

Idiopathic retractile (sclerosing) mesenteritis and its differential diagnosis

Am J Surg Pathol

(1989)

A. Bala et al.

Treatment of sclerosing mesenteritis with corticosteroids and azathioprine

Can J Gastroenterol

(2001)

T. Genereau et al.

Demonstration of efficacy of combining corticosteroids and colchicine in two patients with idiopathic sclerosing mesenteritis

Dig Dis Sci

(1996)

A. Venkataramani et al.

Sclerosing mesenteritis: an unusual cause of abdominal pain in an HIV-positive patient

Am J Gastroenterol

(1997)

P.M. Ginsburg et al.

A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis

Aliment Pharmacol Ther

(2002)

Cited by (228)

Fibrotic phenotype of IgG4-related disease
2024, The Lancet Rheumatology
A prompt response to glucocorticoids is a clinical hallmark of IgG4-related disease. However, manifestations characterised by prominent tissue fibrosis on histological examination can be less responsive to glucocorticoid therapy than other types of IgG4-related disease. These manifestations include retroperitoneal fibrosis, fibrosing mediastinitis, Riedel thyroiditis, orbital pseudotumor, and hypertrophic pachymeningitis, among others. To explain this discrepancy, a preliminary distinction into proliferative and fibrotic phenotypes of IgG4-related disease has been proposed on the basis of clinical presentation, pathological features, and response to immunosuppressive therapy. Implications of this classification for patient management remain an important area of investigation. In this Series paper, we aim to dissect the pathophysiology of tissue fibrosis in IgG4-related disease and discuss how clinicians should approach the management of fibrotic manifestations of IgG4-related disease based on the most recent diagnostic and therapeutic developments.
Mesenteric panniculitis is associated with cardiovascular risk-factors: A case-control study
2022, Digestive and Liver Disease
This study evaluated the prevalence of cardiovascular risk-factors in patients with mesenteric panniculitis.
To determine whether cardiovascular risk-factors and mesenteric panniculitis are associated.
Retrospective, matched case-control study of patients referred to Meir Medical Center, Israel, 2014–2019, who underwent computerized tomography scan, were diagnosed mesenteric panniculitis by radiologic criteria. They were compared to two, matched case-control groups: hospitalized patients without mesenteric panniculitis and the general population based on Israeli Ministry of Health surveys. Patients with active malignancy, IBD or significant intra-abdominal morbidity were excluded.
Of 376 patients with mesenteric panniculitis diagnosed by computerized tomography, 187 were included. Compared to hospital patients, they had higher incidence of dyslipidemia (77.5%/56.7%), hypertension (52.4%/40.6%), obesity (body mass index>30) (60.4%/30.5%) and nonalcoholic fatty liver disease (42.2%/16.6%). Similar differences were observed compared to the general population. In multivariable logistic regression, dyslipidemia, obesity, and nonalcoholic fatty liver disease were independent predictors for mesenteric panniculitis.
Patients with mesenteric panniculitis have more cardiovascular risk-factors compared to a case-control group and to the general population. This suggests that mesenteric panniculitis is clinically significant and may be part of the metabolic morbidity burden. This association should be further explored.
Mesenteric panniculitis various presentations and management: A single institute ten years, experience
2022, Annals of Medicine and Surgery
Mesenteric Panniculitis (MP) is predominately a disease of the small bowel of unknown etiology. Characterized by Fibrosis and chronic inflammation of fatty tissue of the mesentery in the small bowel. It is commonly diagnosed based on computed tomography (CT scan) with IV contrast and biopsies in equivocal cases. We conducted a retrospective study from 2011 to 2020. We analyzed the medical records of 40 patients with Mesenteric Panniculitis. The most common presentation was vague abdominal symptoms. We successfully managed the patients medically with prednisone, azathioprine, colchicine, or a combination. Patients on prednisolone showed good responses clinically and radiologically during follow-up. One patient was operated on and didn't respond to medical therapy.
Association between mesenteric panniculitis and non-neoplastic disorders
2021, Clinical Imaging
To assess the relationship between MP and coexisting non-neoplastic disorders.
Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann–Whitney U, χ², or Fisher's test.
976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064–0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012–0.036).
MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.
A 67-Year-Old Woman With Abdominal Pain and Dyspnea
2021, Chest
A 67-year-old woman presented to her primary physician with a year of periumbilical abdominal discomfort with diarrhea, bloating, and unintentional weight loss. While undergoing workup for the abdominal pain, she presented to the ED with dyspnea that worsened over a few weeks. She had no associated chest pain, lower extremity edema, fevers, or chills, but endorsed orthopnea. The patient’s medical history included hypothyroidism and diabetes mellitus. Her family history was significant for coronary disease in her father and hypertension in her mother. She had no recent travel; she is a nonsmoker and rare alcohol drinker. She worked in administration.
A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People’s Hospital in China
2024, BMC Gastroenterology

View all citing articles on Scopus

View full text

Original articleSclerosing Mesenteritis: Clinical Features, Treatment, and Outcome in Ninety-Two Patients

Section snippets

Methods

Clinical Presentation and Diagnosis

Discussion

Conclusions

Gastroenterology

Dig Liver Dis

Am J Med

J Gastrointest Surg

Hum Pathol

J Steroid Biochem Mol Biol

Chest

Surgery

Endocr Pract

Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity?

Am J Surg Pathol

Sullamesenterite e sclerosante

Policlinico (sezprat)

Mesenteric lipodystrophy

Ann Intern Med

Mesenteric panniculitis: review of the literature and presentation of cases

Surgery

Mesenteric panniculitis: review of 27 cases

Ann Surg

Idiopathic retractile (sclerosing) mesenteritis and its differential diagnosis

Am J Surg Pathol

Treatment of sclerosing mesenteritis with corticosteroids and azathioprine

Can J Gastroenterol

Demonstration of efficacy of combining corticosteroids and colchicine in two patients with idiopathic sclerosing mesenteritis

Dig Dis Sci

Sclerosing mesenteritis: an unusual cause of abdominal pain in an HIV-positive patient

Am J Gastroenterol

A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis

Aliment Pharmacol Ther

Original article
Sclerosing Mesenteritis: Clinical Features, Treatment, and Outcome in Ninety-Two Patients