Serena Thomas J, Solomon Schnurr Carolyn A, Pui John C, Gerken Jeffrey R
General Surgery/Vascular Surgery, Beaumont Health, Livonia, USA.
General Surgery, Michigan State University, Farmington Hills, USA.
Cureus. 2021 Jan 7;13(1):e12546. doi: 10.7759/cureus.12546.
Sclerosing mesenteritis is a rare and often benign condition characterized as a fibrotic disease consisting of non-suppurative inflammation of adipose tissue. Through mass effect, sclerosing mesenteritis can compromise the gastrointestinal lumen as well as mesenteric vessel integrity. There is a poor understanding of this disorder and its pathogenesis, which presents with various symptomatology and often without identification of inciting factors. Patients with sclerosing mesenteritis exhibit gastrointestinal and systemic manifestations including weight loss, fever, nausea, vomiting, diarrhea, and abdominal pain. This case presents a patient with a seven-month history of chronic, epigastric abdominal pain following laparoscopic surgery for acute uncomplicated appendicitis. The patient underwent work-up with computed tomography and magnetic resonance enterography that confirmed the presence of a mesenteric mass of unknown etiology located in the mid-epigastrium. Due to the inability to safely sample the mass, the patient underwent diagnostic laparoscopy, which was subsequently converted to an open procedure where excision of the mesenteric lesion was performed. Surgical pathology revealed fat necrosis with fibrosis, granulomatous inflammation, and dystrophic calcifications consistent with sclerosing mesenteritis. The patient was seen in follow-up with the resolution of her epigastric abdominal pain. This case report demonstrates a unique presentation of a symptomatic patient with a mesenteric mass not amenable to non-invasive biopsy. Complete excision of this lesser sac mass revealed sclerosis mesenteritis as the pathological cause.
硬化性肠系膜炎是一种罕见且通常为良性的病症，其特征为一种由脂肪组织非化脓性炎症构成的纤维化疾病。通过占位效应，硬化性肠系膜炎可损害胃肠道管腔以及肠系膜血管的完整性。人们对这种疾病及其发病机制了解甚少，它表现出各种症状，且往往无法确定诱发因素。硬化性肠系膜炎患者会出现胃肠道和全身症状，包括体重减轻、发热、恶心、呕吐、腹泻和腹痛。本病例介绍了一名患者，在因急性单纯性阑尾炎接受腹腔镜手术后，出现了长达七个月的上腹部慢性腹痛病史。该患者接受了计算机断层扫描和磁共振小肠造影检查，证实在上腹部中部存在一个病因不明的肠系膜肿块。由于无法安全地对肿块进行取样，患者接受了诊断性腹腔镜检查，随后转为开放手术，切除了肠系膜病变。手术病理显示脂肪坏死伴纤维化、肉芽肿性炎症和营养不良性钙化，符合硬化性肠系膜炎。对该患者进行随访时，其 上腹部腹痛已缓解。本病例报告展示了一名有症状患者出现肠系膜肿块且无法进行非侵入性活检的独特表现。完全切除这个网膜囊肿块后发现硬化性肠系膜炎是病理原因。
