Sclerosing mesenteritis as a rare cause of upper ileus

Mihailo Bezmarević; Darko Mirković; Nenad Perišić; Snežana Cerović; Marina Panišić; Saša Micković; Ivana Tufegdžić; Jelena Mitrović; Zoran Djordjević

doi:10.2298/1378

Mihailo Bezmarević Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
Darko Mirković Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Nenad Perišić Clinic for Gastroenterology, Military Medical Academy, Belgrade, Serbia
Snežana Cerović Center of Pathology and Forensic Medicine,Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Marina Panišić Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
Saša Micković Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
Ivana Tufegdžić §Center of Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Serbia
Jelena Mitrović Primary Health Care Center “Dr Simo Milosevic”, Belgrade, Serbia
Zoran Djordjević Institute of Radiology, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/1378

Keywords: panniculitis, peritoneal, intestinal obstruction, diagnosis, surgical procedures, operative, treatment outcome,

Abstract

Introduction. Sclerosing mesenteritis is a rare pathological entity characterized by non-specific tumor-like expansion in mesentery. Accurate diagnosis of this disease is rarely made preoperatively. Surgery takes place in diagnosis, as well in treatment of the disease. We presented a case of sclerosing mesenteritis that affected the final portions of duodenum and initial part of jejunum with clinical picture of upper gastrointestinal obstruction. Case report. A 46-year-old man without previous medical history was presented with vomiting and loss of weight in the last 6 months. Due to suspicion of parapancreatic tumor by CT examination and clinical presentation of the disease, the patient underwent laparotomy. A mass infiltrated mesenteric root, initial part of superior mesenteric artery, the fourth duodenum portion and the ligament of Treitz, while the stomach and duodenum were dilatated. The intraoperative biopsy indicated a benign process. The mass was reduced with desobstruction of the duodenum. Definitively, histopathological finding showed fibromatosis in different phases of activity. Postoperative course passed without complications. The patient continued to receive an immunosuppressive drug therapy. After a 6-month treatment the patient showed no gastrointestinal problems. Conclusion. Sclerosing mesenteritis that affects the duodenum and the proximal part of the jejunum with subacute upper gastrointestinal obstruction is an extremely rare condition. In the presented case a surgical procedure was necessary for marking the diagnosis and treatment as well.

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