https://doi.org/10.53453/ms.2025.1.1
Sclerosing mesenteritis: a case report
Simona Terleckytė
1
, Roberta Buginytė
2
, Sigita Gelman
2
1
Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
2
Lithuanian University of Health Sciences Kaunas Clinics, Department of Gastroenterology, Kaunas, Lithuania
Abstract
Background. Sclerosing mesenteritis (SM) is a rare pathology characterized by chronic, nonspecific
inflammation of the fatty tissue of the intestinal mesentery. The exact causes are unknown, however abdominal
traumas, surgeries, autoimmune disease, tumors may contribute to the development of sclerosing mesenteritis.
The main symptom reported by patients is abdominal pain. The gold standard for diagnosing SM is computed
tomography (CT). Upon diagnosis, treatment with glucocorticoids combined with other immunosuppressants is
prescribed.
Case report. In this case report we analyzed a 46-year-old patient who had been complaining of spasmodic
abdominal pain for two years. Additionally, an increase in C-reactive protein (CRP) levels was observed alongside
the pain. It was decided to perform imaging studies to determine the cause of the abdominal pain. After performing
esopgagogastroduodenoscopy (EGD) and a colonoscopy, no pathology was observed. Antibiotic therapy was
started, however, with no improvement in the condition, abdominal CT scan and magnetic resonance imaging
(MRI) was performed. After imaging studies, inflammation and edema of the small and large intestines were
observed, leading to a diagnosis of sclerosing mesenteritis. The patient was prescribed methylprednisolone.
During treatment, the clinical condition improved, and abdominal pain disappeared.
Conclusion. Sclerosing mesenteritis is a rare pathology that causes chronic abdominal pain. There are many
factors that can contribute to this condition. It is important, after conducting the appropriate tests, to identify
changes characteristic of sclerosing mesenteritis, determine the factors that contributed to its development, and
prescribe treatment.
Keywords: abdominal pain, sclerosing mesenteritis, glucocorticoids
Journal of Medical Sciences. 26 Jan, 2025 - Volume 13 | Issue 1. Electronic - ISSN: 2345-0592
Medical Sciences 2025 Vol. 13 (1), p. 2-6, https://doi.org/10.53453/ms.2025.1.1
2
1. Introduction
Sclerosing mesenteritis (SM) is a rare pathology
characterized by chronic, nonspecific
inflammation of the fatty tissue of the intestinal
mesentery [1]. The prevalence of the disease
ranges from 0.6 to 3.4 percent [2,3]. The exact
causes of sclerosing mesenteritis are unknown,
but it is believed that nonspecific inflammatory
responses to certain diseases and conditions may
contribute to its development . According to the
literature, the disease can develop in patients
following various abdominal traumas or
surgeries, as well as it can be diagnosed in
patients who are suffering from autoimmune
disease, oncological conditions [4,5,6]. In the
literature, isolated cases have been described in
patients with intestinal ischemia or infectious
diseases (tuberculosis, syphilis, influenza, etc.)
[7]. The main symptom reported by patients is
abdominal pain (70%), with less frequent
occurrences of constipation or diarrhea [8,9].
Around 20% of patients may experience
systemic symptoms such as fever, night sweats,
or weight loss [8,9]. During a physical
examination, increased abdominal sensitivity
and muscle tension (without peritoneal irritation)
may be observed [8,9]. The gold standard for
diagnosing sclerosing mesenteritis is computed
tomography (CT) but magnetic resonance
imaging (MRI) may also be used to confirm SM
[10]. We present a case of sclerosing mesenteritis
in a male patient.
2. Case report
A year ago a 46-year-old male presented to a
gastroenterologist, Hospital of Lithuanian
University of Health Sciences, Kaunas Clinics.
A patient complained of persistent, spasmodic
abdominal pain exacerbated after meals.
Additionally, he was experiencing fever, profuse
night sweats, and significant weight loss in the
past 2 years. These complaints have been
accompanied by consistently elevated C-reactive
protein (CRP) levels (70-100 mg/l). During
physical examination, there was tenderness in
the right iliac fossa, with tense abdominal
muscles, although there was no evidence of
peritoneal irritation. A blood test showed CRP
level of 200 mg/l. An abdominal X – ray
revealed that the intestines were filled with gas
and content with segments of the small intestine
appearing dilated. And esopgagogastro-
duodenoscopy (EGD) was performed during
which no abnormalities were observed. From the
patient’s medical history, it was known that in
January 2023 due to persistent abdominal pain
an abdominal CT (Figure 1,2) was performed,
revealing changes consistent with focal nodular
hyperplasia (FNH) of the liver. Also, the CT scan
revealed that the sigmoid colon was elongated,
tortuous, and circumferentially thickened, with
peritoneal and omental changes resembling
carcinosis. There was suspicion of a tumor in the
sigmoid colon, but after performing a
colonoscopy, no pathology was observed. Based
on the results of the previously conducted tests
and the patient’s condition was not improving,
abdominal MRI was performed. In the
abdominal MRI (Figure 3), a focal lesion
characteristic of FNH (focal nodular
hyperplasia) was observed in the liver with no
negative dynamics. On the right side of the
abdomen, the wall of the small intestine was
significantly thickened and distinctly
edematous. The surrounding fatty tissue also
exhibited marked edema, resembling
inflammatory changes. After evaluating the
conducted tests, empirical antibiotic therapy
with cefuroxime and metronidazole was
prescribed. However, with no improvement in
Journal of Medical Sciences. 26 Jan, 2025 - Volume 13 | Issue 1. Electronic - ISSN: 2345-0592
3
the patient's condition and worsening of
abdominal pain, a repeat abdominal CT scan
(Figure 4) was performed. It revealed that the
inflammatory changes in the intestines on the
right side of the abdominal cavity were more
pronounced and infiltration was already
observed in both the small and large intestine
with lymph nodes measuring up to 0,6 cm. Thus,
after conducting CT and MRI, inflammation and
edema of the small and large intestines were
observed, leading to a diagnosis of sclerosing
mesenteritis. The patient was prescribed
methylprednisolone 40 mg intravenous. During
treatment, the clinical condition improved,
abdominal pain disappeared and there was a
positive trend in inflammatory markers.
Additional tests were performed to investigate
the cause of SM. Head MRI, chest CT,
abdominal ultrasound and enteroscopy were
performed but these tests revealed no pathology
and ruled out suspected the small bowel Crohn's
disease, systemic vasculitis, and infectious
process. Additionally, EGD was conducted with
biopsies of the duodenum. Biopsy results
revealed the parasitic infection in the small
intestine caused by the protozoan Giardia
lamblia. After conducting tests and with the
improvement of the condition, the patient was
discharged for outpatient treatment, with a
prescription for prednisolone and additional
azathioprine. After the course of treatment, the
patient did not express any complaints and no
longer experienced abdominal pain, so
prednisolone was gradually discontinued with
continuing azathioprine alone.
3. Discussion
Sclerosing mesenteritis can involve not only the
fatty tissue of the mesentery but also affect the
omentum, intestinal mucosa, and blood vessels
supplying the intestine [1]. It is a rare disease
with approximately from 200 to 300 cases
described in the literature[11,12]. SM is most
diagnosed in the fifth or sixth decade of life
[11,12]. About 15 % of all cases of the disease
involve asymptomatic patients or those with
minimal symptoms [8,9]. Most of the
symptomatic patients complain of persistent
abdominal pain, often without a specific cause
[13,14]. The pathogenesis of SM is not fully
understood but it is believed that various factors
such as trauma, surgeries, autoimmune disease,
oncological conditions, infections, ischemia may
contribute to the development of this disease
[8,9]. While there is limited literature on the
association between giardiasis and the
development of SM, this parasitic infection
could be one of the etiological factors [7]. SM
can be diagnosed incidentally on the abdominal
CT scans. The most observed sign is the soft
tissue mass at the root of the small intestine
mesentery [10]. Enlarged mesenteric or
retroperitoneal lymph nodes and thickened
intestinal walls may also be seen on CT images
[10,15]. Another diagnostic method for
identifying SM is MRI, which shows a
hyperintense signal on T2-weighted images
(edema), along with enlarged lymph nodes [16].
Upon diagnosing sclerosing mesenteritis,
treatment is prescribed depending on whether
the patient experiences symptoms or not [1,5]. If
the disease is diagnosed incidentally and there
are no clinical symptoms, then treatment is not
indicated, only patient monitoring is necessary.
When observing inflammatory changes, patients
are often prescribed glucocorticoids (GCK)
along with other immunosuppressants
(tamoxifen, azathioprine, cyclophosphamide)
[1,5]. At the beginning of treatment,
prednisolone is commonly prescribed, with an
Journal of Medical Sciences. 26 Jan, 2025 - Volume 13 | Issue 1. Electronic - ISSN: 2345-0592
4
attempt to gradually taper the dose over 3
months, continuing only with maintenance
immunosuppressant therapy, or maintaining
minimal GCK supportive doses [1,5]. In rare
cases, when conservative treatment is ineffective
or complications arise (perforation, obstruction,
etc.), surgical intervention may be required [1,5].
4. Conclusions
Our patient is one of the rare cases with SM. He
presented with chronic abdominal pain and
systemic symptoms. Various instrumental
examinations were conducted to identify the
cause of the pain, which did not reveal any clear
pathology initially. However, progressive
inflammatory changes in the intestines were
identified. Based on the complaints and findings
from instrumental tests, the patient's condition
was diagnosed as sclerosing mesenteritis.
Figure 1 Sigmoid colon changes
Figure 2 Fatty changes
Figure 3 Inflammatory changes in the small intestine
Figure 4 In the right abdominal cavity, the
inflammatory changes in the bowel were more
pronounced and of larger extent over time
Journal of Medical Sciences. 26 Jan, 2025 - Volume 13 | Issue 1. Electronic - ISSN: 2345-0592
5
References
1. Akram S, Pardi DS, Schaffner JA, Smyrk TC.
Sclerosing mesenteritis: clinical features,
treatment, and outcome in ninety-two
patients. Clin Gastroenterol
Hepatol. 2007;5(5):589–596.
doi: 10.1016/j.cgh.2007.02.032.
2. Daskalogiannaki M, Voloudaki A,
Prassopoulos P, et al. CT evaluation of
mesenteric panniculitis: prevalence and
associated diseases. AJR Am J Roentgenol 2000;
174:427.
3. Kuhrmeier A. Mesenteric lipodystrophy.
Schweiz Med Wochenschr 1985;115:1218-24
4. Sharma P, Yadav S, Needham CM, Feuerstadt
P. Sclerosing mesenteritis: a systematic review
of 192 cases. Clin J Gastroenterol 2017; 10:103.
5. Bala A, Coderre SP, Johnson DR, Nayak V.
Treatment of sclerosing mesenteritis with
corticosteroids and azathioprine. Can J
Gastroenterol 2001; 15:533.
6. Scheer F, Spunar P, Wiggermann P, et al.
Mesenteric Panniculitis (MP) in CT - A
Predictor of Malignancy? Rofo 2016; 188:926.
7. TEDESCHI CG, BOTTA GC. Retractile
mesenteritis. N Engl J Med 1962; 266:1035.
8. Durst AL, Freund H, Rosenmann E, Birnbaum
D. Mesenteric panniculitis: review of the
leterature and presentation of cases. Surgery
1977; 81:203.
9. Emory TS, Monihan JM, Carr NJ, Sobin LH.
Sclerosing mesenteritis, mesenteric panniculitis
and mesenteric lipodystrophy: a single entity?
Am J Surg Pathol 1997; 21:392.
10. Horton KM, Lawler LP, Fishman EK. CT
findings in sclerosing mesenteritis (panniculitis):
spectrum of disease. Radiographics 2003;
23:1561.
11. Sharma P, Yadav S, Needham CM,
Feuerstadt P. Sclerosing mesenteritis: a
systematic review of 192 cases. Vol. 10, Clinical
Journal of Gastroenterology. Springer Tokyo;
2017. p. 103–11.
12. Saha B, Tome J, Wang XJ. Sclerosing
Mesenteritis: A Concise Clinical Review for
Clinicians. Vol. 99, Mayo Clinic Proceedings.
Elsevier Ltd; 2024. p. 812–20.
13. Pereira JPT, Romão V, Eulálio M, Jorge R,
Breda F, Calretas S, et al. Sclerosing mesenteritis
and disturbance of glucose metabolism: A new
relationship? A case series. American Journal of
Case Reports. 2016 Feb 1;17:55–9.
14. Corado SC, Almeida H, Baltazar JR. A
severe case of sclerosing mesenteritis. BMJ Case
Rep. 2019 Jul 1;12(7).
15. Badet N, Sailley N, Briquez C, et al.
Mesenteric panniculitis: still an ambiguous
condition. Diagn Interv Imaging 2015; 96:251.
16. Ghanem N, Pache G, Bley T, et al. MR
findings in a rare case of sclerosing mesenteritis
of the mesocolon. J Magn Reson Imaging 2005;
21:632.,
Journal of Medical Sciences. 26 Jan, 2025 - Volume 13 | Issue 1. Electronic - ISSN: 2345-0592
6