Hermann F, Speich R, Schneemann M
Medizinische Klinik B Departement für Innere Medizin, Universitätsspital Zürich, Switzerland.
Dtsch Med Wochenschr. 2003 Jun 20;128(25-26):1395-8. doi: 10.1055/s-2003-40106.
A 69-year-old man had a history of chronic abdominal pain and intermittent fever for more than 10 years. Due to acute epigastric pain and intermittent fever with night sweat for one week he was admitted for further investigation. On physical examination there was tenderness in the right upper and lower epigastrium without a palpable mass.
Laboratory figures showed signs of inflammation with a CRP of 103 mg/l. Leucocyte counts were normal without left shift. CT and MRI scans showed a sharp-edged mass of 10 x 8 cm in diameter in the retroperitoneal area with big vessels running through it. Laparoscopic biopsy confirmed the suspected diagnosis of retractile mesenteritis.
Under therapy with oral progesterone (Utrogestan 1 x 100 mg/d) and prednisone (Prednison 1 x 50 mg/d) there was fast symptomatic relief. A CT scan 2 months after initial diagnosis showed clear regression of the tumor.
Retractile mesenteritis is a rare cause of chronic abdominal pain with variable symptoms. Its aetiology is unknown. In case of bowel ischemia a surgical approach is preferred, milder forms may be treated with immunosuppressive agents as well as oral progesterone. Progesterone has exhibited positive effects on fatty tissue with successful treatment in desmoid tumors and retroperitoneal fibrosis. Here in we could demonstrate its safe and efficient use in a patient with retractile mesenteritis.
一名69岁男性有超过10年的慢性腹痛和间歇性发热病史。因急性上腹部疼痛以及伴有盗汗的间歇性发热1周入院进一步检查。体格检查发现上腹部右上象限和右下象限有压痛，未触及肿块。
实验室检查结果显示有炎症迹象，C反应蛋白为103mg/L。白细胞计数正常，无核左移。CT和MRI扫描显示腹膜后区域有一个直径为10×8cm的边缘清晰的肿块，有大血管穿过。腹腔镜活检证实了缩窄性肠系膜炎的疑似诊断。
口服孕激素（安琪坦100mg/d）和泼尼松（强的松50mg/d）治疗后症状迅速缓解。初次诊断2个月后的CT扫描显示肿瘤明显缩小。
缩窄性肠系膜炎是慢性腹痛的罕见原因，症状多样。其病因不明。对于肠缺血患者，首选手术治疗，较轻的病例也可用免疫抑制剂和口服孕激素治疗。孕激素已在硬纤维瘤和腹膜后纤维化的成功治疗中显示出对脂肪组织有积极作用。在此我们证明了其在缩窄性肠系膜炎患者中的安全有效应用。
