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Z Gastroenterol 2012; 50(9): 1013-1017
DOI: 10.1055/s-0031-1299501
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Enteroskopie und Bildgebung bei sklerosierender Mesenteritis

Enteroscopy and Imaging in Sclerosing Mesenteritis
U. Gottschalk
1   Gastroenterologie, Diabetologie und allgemeine Innere Medizin, Innere Medizin, Caritas-Klinik Pankow, Berlin
,
C. Nitzsche
2   Radiologie, Caritas-Klinik Pankow, Berlin
,
J. Felber
3   Onkologische Schwerpunktpraxis, Berlin
,
C. F. Dietrich
4   Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim
› Author Affiliations
Further Information

Publication History

09 January 2012

25 March 2012

Publication Date:
10 September 2012 (online)

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Zusammenfassung

Die sklerosierende Mesenteritis ist eine seltene, gutartige und chronisch fibrosierende Entzündung des mesenterialen Fettgewebes. Die Ätiologie ist unklar. In dieser Kasuistik beschreiben wir den Fall einer 56-jährigen Frau, welche aufgrund postprandialer Schmerzen und Gewichtsverlust stationär aufgenommen wurde. In der Sonografie, der Computertomografie und der Magnetresonanztomografie fanden wir einen 15 cm großen Tumor des Mesenteriums, wobei die Befunde typisch für eine sklerosierende Mesenteritis waren. Zusätzlich erfolgte eine Single-Ballon-Enteroskopie, in welcher sich eine erhebliche hypererge Reaktion der Mukosa des Ileums zeigte. Der histologische Befund ist geeignet, die Verdachtsdiagnose zu unterstützen. Unter der Therapie mit Tamoxifen besserten sich die Symptome der Patientin.

Abstract

Sclerosing mesenteritis is a rare, benign, and chronic fibrosing inflammatory disease of the mesenteric fatty tissue. Its aetiology is unknown. In the present report we describe a 56-year-old women who presented with postprandial abdominal pain, and weight loss. Ultrasound, computed tomography, and magnetic resonance imaging revealed a mesenteric mass of 15 cm. The findings were typical for this disease. Additionally the patient underwent a single ballon enteroscopy in which the mucosa showed a considerable hyperergic reaction. The histological examination of the ileum was appropriate to support the suspicion. The patient’s symptoms responded to a therapy with tamoxifen.

Schlüsselwörter

Mesenteritis - Enteroskopie - Tamoxifen

Key words

mesenteriitis - enteroscopy - tamoxifen
 

  • Literatur

  • 1 Emory TS, Monihan JM, Carr NJ et al. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity?. The American journal of surgical pathology 1997; 21: 392-398
    CrossrefPubMedGoogle Scholar
  • 2 Lawler LP, McCarthy DM, Fishman EK et al. Sclerosing mesenteritis: depiction by multidetector CT and three-dimensional volume rendering. American journal of roentgenology 2002; 178: 97-99
    CrossrefPubMedGoogle Scholar
  • 3 Sabate JM, Torrubia S, Maideu J et al. Sclerosing mesenteritis: imaging findings in 17 patients. American journal of roentgenology 1999; 172: 625-629
    CrossrefPubMedGoogle Scholar
  • 4 Han SY, Koehler RE, Keller FS et al. Retractile mesenteritis involving the colon: pathologic and radiologic correlation (case report). American journal of roentgenology 1986; 147: 268-270
    CrossrefPubMedGoogle Scholar
  • 5 Verzaro R, Guadagni S, Agnifili A et al. Retractile mesenteritis involving the colon. The European journal of surgery = Acta chirurgica 1994; 160: 523-524
    PubMedGoogle Scholar
  • 6 Akram S, Pardi DS, Schaffner JA et al. Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 2007; 5: 589-596 ; quiz 523–524
    CrossrefPubMedGoogle Scholar
  • 7 McCrystal DJ, O’Loughlin BS, Samaratunga H. Mesenteric panniculitis: a mimic of malignancy. The Australian and New Zealand journal of surgery 1998; 68: 237-239
    CrossrefPubMedGoogle Scholar
  • 8 Edlich RF, Woodard CR, Pine SA et al. Hazards of powder on surgical and examination gloves: a collective review. Journal of long-term effects of medical implants 2001; 11: 15-27
    PubMedGoogle Scholar
  • 9 Delgado Plasencia L, Rodriguez Ballester L, Lopez-Tomassetti Fernandez EM et al. Mesenteric panniculitis: experience in our center. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 2007; 99: 291-297
    PubMedGoogle Scholar
  • 10 Daskalogiannaki M, Voloudaki A, Prassopoulos P et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. American journal of roentgenology 2000; 174: 427-431
    CrossrefPubMedGoogle Scholar
  • 11 Ege G, Akman H, Cakiroglu G. Mesenteric panniculitis associated with abdominal tuberculous lymphadenitis: a case report and review of the literature. The British journal of radiology 2002; 75: 378-380
    PubMedGoogle Scholar
  • 12 Cuff R, Landercasper J, Schlack S. Sclerosing mesenteritis. Surgery 2001; 129: 509-510
    PubMedGoogle Scholar
  • 13 Shah AN, You CH. Mesenteric lipodystrophy presenting as an acute abdomen. Southern medical journal 1982; 75: 1025-1026
    CrossrefPubMedGoogle Scholar
  • 14 Patel N, Saleeb SF, Teplick SK. General case of the day. Mesenteric panniculitis with extensive inflammatory involvement of the peritoneum and intraperitoneal structures. Radiographics: a review publication of the Radiological Society of North America, Inc 1999; 19: 1083-1085
    PubMedGoogle Scholar
  • 15 Durst AL, Freund H, Rosenmann E et al. Mesenteric panniculitis: review of the leterature and presentation of cases. Surgery 1977; 81: 203-211
    PubMedGoogle Scholar
  • 16 Kipfer RE, Moertel CG, Dahlin DC. Mesenteric lipodystrophy. Annals of internal medicine 1974; 80: 582-588
    CrossrefPubMedGoogle Scholar
  • 17 Parampalli U, Banerjee S, Dey SR et al. An unusual presentation of sclerosing mesenteritis mimicking inflammatory bowel disease in a teenager. JRSM short reports 2011; 2: 16
    CrossrefPubMedGoogle Scholar
  • 18 Daghfous A, Bedioui H, Baraket O et al. Mesenteric panniculitis simulating malignancy. La Tunisie medicale 2010; 88: 950-953
    PubMedGoogle Scholar
  • 19 Ali FN, Ishaque S, Jamil B et al. Sclerosing mesenteritis as a cause of abdominal mass and discomfort in an elderly patient: a case report and literature review. Case reports in medicine 2010; 2010: 625321
    PubMedGoogle Scholar
  • 20 Kida T, Suzuki K, Matsuyama T et al. Sclerosing mesenteritis presenting as protein-losing enteropathy: a fatal case. Internal medicine 2011; 50: 2845-2849
    CrossrefPubMedGoogle Scholar
  • 21 Hassan T, Balsitis M, Rawlings D et al. Sclerosing mesenteritis presenting with complete small bowel obstruction, abdominal mass and hydronephrosis. Irish journal of medical science 2010; DOI: 10.1007/s11845-010-0495-1.
    PubMedGoogle Scholar
  • 22 Kornprat P, Liegl-Atzwanger B, Portugaller H et al. Sclerosing mesenteritis, a rare cause of a retroperitoneal tumor. Wiener klinische Wochenschrift 2010; 122: 179-183
    CrossrefPubMedGoogle Scholar
  • 23 Vettoretto N, Diana DR, Poiatti R et al. Occasional finding of mesenteric lipodystrophy during laparoscopy: a difficult diagnosis. World journal of gastroenterology: WJG 2007; 13: 5394-5396
    PubMedGoogle Scholar
  • 24 Chawla S, Yalamarthi S, Shaikh IA et al. An unusual presentation of sclerosing mesenteritis as pneumoperitoneum: case report with a review of the literature. World journal of gastroenterology: WJG 2009; 15: 117-120
    CrossrefPubMedGoogle Scholar
  • 25 Arora M, Dubin E. A clinical case study: sclerosing mesenteritis presenting as chylous ascites. Medscape journal of medicine 2008; 10: 30
    PubMedGoogle Scholar
  • 26 Bae JH, Kim SH, Ahn SB et al. A case of idiopathic sclerosing mesenteritis with retroperitoneal fibrosis. The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 2011; 58: 221-225
    CrossrefPubMedGoogle Scholar
  • 27 Belghiti H, Cazals-Hatem D, Couvelard A et al. Sclerosing mesenteritis: can it be a IgG4 dysimmune disease?. Annales de pathologie 2009; 29: 468-474
    CrossrefPubMedGoogle Scholar
  • 28 Salvarani C, Valli R, Boiardi L et al. IgG4-associated sclerosing mesenteritis. Clinical and experimental rheumatology 2011; 29: 79-S80
    PubMedGoogle Scholar
  • 29 Biscaldi E, Romairone E, Rollandi GA. Regarding six cases of mesenteric panniculitis: US, spiral CT, Magnetic Resonance. La Radiologia medica 2002; 103: 511-518
    PubMedGoogle Scholar
  • 30 Gu GL, Wang SL, Wei XM et al. Sclerosing mesenteritis as a rare cause of abdominal pain and intraabdominal mass: a cases report and review of the literature. Cases journal 2008; 1: 242
    CrossrefPubMedGoogle Scholar
  • 31 Issa I, Baydoun H. Mesenteric panniculitis: various presentations and treatment regimens. World journal of gastroenterology: WJG 2009; 15: 3827-3830
    CrossrefPubMedGoogle Scholar
  • 32 Durst AL, Yarom R, Luttwak EM. Malignant fibromatous peritoneal mesothelioma associated with liposclerotic mesenteritis. The American journal of gastroenterology 1971; 55: 477-481
    PubMedGoogle Scholar
  • 33 Bala A, Coderre SP, Johnson DR et al. Treatment of sclerosing mesenteritis with corticosteroids and azathioprine. Canadian journal of gastroenterology = Journal canadien de gastroenterologie 2001; 15: 533-535
    PubMedGoogle Scholar
  • 34 Genereau T, Bellin MF, Wechsler B et al. Demonstration of efficacy of combining corticosteroids and colchicine in two patients with idiopathic sclerosing mesenteritis. Digestive diseases and sciences 1996; 41: 684-688
    CrossrefPubMedGoogle Scholar
  • 35 Mazure R, Fernandez Marty P, Niveloni S et al. Successful treatment of retractile mesenteritis with oral progesterone. Gastroenterology 1998; 114: 1313-1317
    CrossrefPubMedGoogle Scholar
  • 36 Ginsburg PM, Ehrenpreis ED. A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis. Alimentary pharmacology & therapeutics 2002; 16: 2115-2122
    CrossrefPubMedGoogle Scholar
  • 37 Bush RW, Hammar Jr SP, Rudolph RH. Sclerosing mesenteritis. Response to cyclophosphamide. Archives of internal medicine 1986; 146: 503-505
    PubMedGoogle Scholar
  • 38 Nobili C, Degrate L, Caprotti R et al. Extensive sclerosing mesenteritis of the rectosigmoid colon associated with erosive colitis. Gastroenterology research and practice 2009; 2009: 176793
    PubMedGoogle Scholar
  • 39 Kapsoritakis AN, Rizos CD, Delikoukos S et al. Retractile mesenteritis presenting with malabsorption syndrome. Successful treatment with oral pentoxifylline. Journal of gastrointestinal and liver diseases: JGLD 2008; 17: 91-94
    PubMedGoogle Scholar
  • 40 Vlachos K, Archontovasilis F, Falidas E et al. Sclerosing Mesenteritis: Diverse clinical presentations and dissimilar treatment options. A case series and review of the literature. International archives of medicine 2011; 4: 17
    CrossrefPubMedGoogle Scholar
  • 41 Koornstra JJ, van Olffen GH, van Noort G. Retractile mesenteritis: to treat or not to treat. Hepato-gastroenterology 1997; 44: 408-410
    PubMedGoogle Scholar
  • 42 Katsanos KH, Ioachim E, Michail M et al. A fatal case of sclerosing mesenteritis. Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2004; 36: 153-156
    CrossrefPubMedGoogle Scholar