Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery. It produces tumor-like masses of the mesentery composed of varying degrees of fibrosis, chronic inflammation, and fat necrosis. It has been described variously as fibrosing mesenteritis, retractile mesenteritis, mesenteric Weber Christian disease, and systemic nodular panniculitis. The etiology and pathogenesis of the disease are as yet unknown, but autoimmune disorder, previous abdominal surgery, trauma, and ischemia could play a role. The clinical features include abdominal pain, vomiting, diarrhea, and constipation. Occasionally, patients with this condition may present with bowel obstruction. Rarely, It can be associated with other idiopathic inflammatory disorders such as retroperitoneal fibrosis, sclerosing cholangitis, and orbital pseudotumors. We report a case of idiopathic sclerosing mesenteritis with retroperitoneal fibrosis in a 58-year-old man.
Anti-Inflammatory Agents/therapeutic use ; Antineoplastic Agents, Hormonal/therapeutic use ; Diagnosis, Differential ; Humans ; Laparoscopy ; Male ; Middle Aged ; Panniculitis, Peritoneal/complications/*diagnosis/drug therapy ; Prednisolone/therapeutic use ; Retroperitoneal Fibrosis/complications/*diagnosis/pathology ; Tamoxifen/therapeutic use ; Tomography, X-Ray Computed

An optimal treatment for cap polyposis has not been established. Several treatment approaches, including anti-inflammatory agents, antibiotics, immunomodulators, and endoscopic therapy have been described. Surgical resection of the affected colon and rectum may be indicated for patients with persistent disease. Repeat surgery is indicated in cases of recurrence after surgery. However, symptomatic polyposis may still recur, and spontaneous resolution of cap polyposis is possible. We report a case of recurrent cap polyposis complicated with retroperitoneal fibrosis after inadequate low anterior resection with a positive resection margin. Surgical approaches for the treatment of cap polyposis should be carefully considered before treatment.
Anti-Inflammatory Agents/therapeutic use ; Colonic Polyps/surgery ; Colonoscopy ; Female ; Humans ; Intestinal Polyposis/complications/*diagnosis/pathology ; Middle Aged ; Prednisolone/therapeutic use ; Recurrence ; Retroperitoneal Fibrosis/complications/*diagnosis/drug therapy ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical features and outcomes of 18 patients with retroperitoneal fibrosis (RPF).

METHODWe retrospectively analyzed the clinical data of 18 RPF patients who received treatment in Peking Union Medical College Hospital from 1988 to 2004.

RESULTSThe initial symptoms included abdominal pain, notalgia, abdominal distension, and pyrexia. Elevated erythrocyte sedimentation rate (35-120 mm/h), immunoglobumin, and gamma globulin levels were found in 12 patients (66.7%), 4 patients (22.2%), and 5 patients (27.8%), respectively. Mild positive antinuclear antibody (1:160-1:320) was found in 3 patients (16.7%). Urethral obstructions were found by ultrasonography and intravenous pyelography, and the existence of post-peritoneal soft tissue shadow was confirmed by computerized tomography and magnetic resonance imaging. The final diagnosis included 15 primary RPF cases and 3 secondary RPF cases. Eleven patients only received drug therapy and 6 patients underwent surgery. The conditions improved in most patients, except that one patient died of tumor.

CONCLUSIONSThe initial symptoms of RPF are not specific. For patients with positive laboratory and radiological examination results, further imagings, surgeries, or interventional therapy may be considered.

Abdominal Pain ; complications ; Blood Sedimentation ; Fever ; complications ; Humans ; Immunoglobulins ; metabolism ; Magnetic Resonance Imaging ; Retroperitoneal Fibrosis ; diagnosis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Ultrasonography ; Urethral Obstruction ; diagnostic imaging ; gamma-Globulins ; metabolism