Lim Huei-Wen, Sultan Keith S
Department of Internal Medicine, Northwell Health, Manhasset, NY, USA.
Department of Gastroenterology and Hepatology, Northwell Health, Manhasset, NY, USA.
Am J Case Rep. 2017 Jun 22;18:696-699. doi: 10.12659/ajcr.904382.
BACKGROUND Sclerosing mesenteritis (SM) is a rare idiopathic inflammation and fibrosis of the mesentery. Its etiology and pathogenesis remain unclear. It has been linked to abdominal trauma related to peritoneal dialysis, recent abdominal surgery, idiopathic inflammatory disorder, paraneoplastic syndrome, ischemia/infection, and autoimmunity. Abdominal CT is the most sensitive imaging modality, and diagnosis is usually confirmed by surgical biopsy. Patients most often present with abdominal pain, nausea, vomiting, diarrhea, and weight loss, and less commonly with chylous ascites and small bowel obstruction. Treatment is usually supportive; surgical intervention may be attempted for life-threatening complications such as bowel obstruction or perforation. CASE REPORT This report describes an 80-year-old man with hypertension and end-stage renal disease (ESRD) presenting with increasing abdominal pain and tenderness over the past 5 months. Abdominal enhanced computed tomography (CT) revealed a fat-ring sign and peritoneal calcifications along the serosa surface of small bowel consistent with sclerosing mesenteritis. His hospital course was complicated by increasing ascites requiring multiple ultrasound-guided paracentesis, worsening leukocytosis, and persistent hypotension after dialysis, requiring pressor support. Ascitic fluid analysis was consistent with chylous ascites. The patient subsequently developed small bowel obstruction causing focal perforation, leading to the death of our patient. In this report, we review the clinical presentation, radiographic findings, treatment, and outcome in our patient and review the relevant literature. CONCLUSIONS Diagnosis of sclerosing mesenteritis is challenging due to its nonspecific clinical features. Sclerosing mesenteritis is a debilitating albeit self-limiting disorder that can rarely become fulminant, largely due to its complications.
背景 硬化性肠系膜炎（SM）是一种罕见的肠系膜特发性炎症和纤维化疾病。其病因和发病机制尚不清楚。它与腹膜透析相关的腹部创伤、近期腹部手术、特发性炎症性疾病、副肿瘤综合征、缺血/感染及自身免疫有关。腹部CT是最敏感的影像学检查方式，通常通过手术活检确诊。患者最常表现为腹痛、恶心、呕吐、腹泻和体重减轻，较少见的表现为乳糜性腹水和小肠梗阻。治疗通常为支持性治疗；对于肠梗阻或穿孔等危及生命的并发症可尝试手术干预。病例报告 本报告描述了一名80岁患有高血压和终末期肾病（ESRD）的男性，在过去5个月中出现腹痛加重和压痛。腹部增强计算机断层扫描（CT）显示脂肪环征以及沿小肠浆膜表面的腹膜钙化，符合硬化性肠系膜炎表现。他的住院过程因腹水增多需多次超声引导下腹腔穿刺、白细胞增多加重以及透析后持续低血压需使用升压药支持而变得复杂。腹水分析符合乳糜性腹水。患者随后发生小肠梗阻并导致局灶性穿孔，最终死亡。在本报告中，我们回顾了该患者的临床表现、影像学检查结果、治疗及结局，并复习了相关文献。结论 由于硬化性肠系膜炎临床特征不具特异性，其诊断具有挑战性。硬化性肠系膜炎是一种使人虚弱但自限性的疾病，极少情况下会发展为暴发性，主要是由于其并发症所致。
