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Sclerosing mesenteritis: a systematic review of 192 cases

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Abstract

Introduction

Sclerosing mesenteritis includes a spectrum of inflammatory disorders involving the adipose tissue of the bowel mesentery.

Aim

To perform a systematic review of previously reported cases of sclerosing mesenteritis (SM) to determine the epidemiology, risk factors, methods of diagnosis, treatment patterns and outcomes for this disease.

Methods

Medline, PubMed, Google Scholar and Cochrane database were searched using keywords mesenteric panniculitis, retractile mesenteritis, mesenteric lipodystrophy and sclerosing mesenteritis. Data was collated into a single excel database, transferred into SPSS (Version 21.0) and analyzed.

Results

Patients diagnosed with SM were between ages of 3 and 88 with a mean age of 55 ± 19.2 years. SM was more common in Caucasians (n = 28, 60.8% of those reporting ethnicity) and men (n = 133, 69.3%) with a male to female ratio of 2.3:1. 28.6% (n = 55) of patients reported a prior abdominal surgery or abdominal trauma, 8.9% (n = 17) had a history of malignancy, and 5.7% (n = 11) of autoimmune disease. 85.4% (n = 164) underwent surgical abdominal exploration (open or laparoscopic); 41.7% (n = 80) had surgery with resection of the involved bowel and mesentery. 34.9% (n = 67) of patients received medical treatment with the majority of them receiving steroids (n = 56, 83.5%). Symptom duration of more than a month (66.7% vs 40.4%, p < 0.05), underlying autoimmune disorder (14.3% vs 4.0%, p < 0.05) or low protein (14.3% vs 4.0%, p < 0.05) at presentation were seen more frequently in those with poor treatment response whereas patients with tender abdomen (45.0% vs 19.0%, p < 0.05) or leukocytosis (20.5% vs 0.0%, p < 0.05) at presentation were likely to have good response to therapy. The most common complications included bowel obstruction/ileus/ischemia (n = 10, 23.8%) and obstructive uropathy/renal failure (n = 10, 23.8%). There were a total of 14 deaths, 12 (85.7%) of which were secondary to SM related complications.

Conclusion

SM is a poorly understood chronic inflammatory disease. Our study is the first systematic review of the published cases of SM. Future work is required to better understand this disease and its optimal therapy.

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Authors and Affiliations

  1. Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA

    Prabin Sharma & Christine Marie Needham

  2. Department of Internal Medicine, Beaumont Health, Royal Oak, MI, 48073, USA

    Siddhartha Yadav

  3. Gastroenterology Center of Connecticut, Clinical Instructor of Medicine, Yale University School of Medicine, Hamden, 06518, CT, USA

    Paul Feuerstadt

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  1. Prabin Sharma
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Correspondence to Prabin Sharma.

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Funding:

This research received no specific grant or funds from any agency in the public, commercial or not-for-profit sectors.

Conflict of interest:

Prabin Sharma, Siddhartha Yadav and Christine Marie Needham have no affiliations with or involvement in any organization or entity with financial or non-financial interest in the subject matter or materials discussed in this manuscript. Paul Feuerstadt is on the speakers bureau and has consulted for Merck and Co., Enterahealth and Allergan.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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This study does not involve human subjects and does not apply to giving Informed Consent,

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Sharma, P., Yadav, S., Needham, C.M. et al. Sclerosing mesenteritis: a systematic review of 192 cases. Clin J Gastroenterol 10, 103–111 (2017). https://doi.org/10.1007/s12328-017-0716-5

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