Images for surgeons
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Sclerosing mesenteritis: a diagnosis worth considering Abdominal pain is common and often leads to diagnostic imaging, such as computed tomography (CT). The finding of diffuse inflammatory change or a focal mass lesion within the gastrointestinal mesentery can make a formal diagnosis difficult. Sclerosing mesenteritis can give rise to such non-specific symptoms and radiological findings. This diagnosis may occur as a distinct entity, or as a manifestation of the recently defined group of immunoglobulin G-related diseases (IgG4-RD).1 We report one example of five recent cases of sclerosing mesenteritis to underscore the diffuse nature of this disease and to increase the awareness of this increasingly common diagnosis. A 71-year-old man with a history of hypertension and ischaemic heart disease presented to his general practitioner with a history of colicky, central abdominal pain. His examination was unremarkable. A CT showed a partially calcified mesenteric mass (75 × 31 mm) abutting the jejunum (Fig. 1). The appearance and location were thought to be consistent with a neuroendocrine tumour (NET). A subsequent chromogrannin A level was found to be mildly elevated (107 pg/L; normal
291
Sclerosing mesenteritis: a diagnosis worth considering Abdominal pain is common and often leads to diagnostic imaging, such as computed tomography (CT). The finding of diffuse inflammatory change or a focal mass lesion within the gastrointestinal mesentery can make a formal diagnosis difficult. Sclerosing mesenteritis can give rise to such non-specific symptoms and radiological findings. This diagnosis may occur as a distinct entity, or as a manifestation of the recently defined group of immunoglobulin G-related diseases (IgG4-RD).1 We report one example of five recent cases of sclerosing mesenteritis to underscore the diffuse nature of this disease and to increase the awareness of this increasingly common diagnosis. A 71-year-old man with a history of hypertension and ischaemic heart disease presented to his general practitioner with a history of colicky, central abdominal pain. His examination was unremarkable. A CT showed a partially calcified mesenteric mass (75 × 31 mm) abutting the jejunum (Fig. 1). The appearance and location were thought to be consistent with a neuroendocrine tumour (NET). A subsequent chromogrannin A level was found to be mildly elevated (107 pg/L; normal
