Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series

Pereira, João Pedro Tavares; Romão, Vera; Eulálio, Margarida; Jorge, Rita Luciana Saraiva; Breda, Filipe; Calretas, S.; Leitão, Sara; Eugénio, Gisela; Santos, Rui M; Carvalho, Armando

doi:10.12659/ajcr.896145

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…Dying adipocytes causes inflow of macrophages to adipose tissue and synthesis of proinflammatory cytokines (IL1, IL-6, TNFα), finally leading to increase of insulin resistance via activation of intracellular pathways such as NFκB and JNK. In the SM, the inflammation process is even more intensified and chronic, which presumably makes the development of insulin resistance and diabetes mellitus even easier [ 7 , 8 ]. In connection with the above, it seems that the inflammatory process occurring in the progress of SM was one of the main causes of metabolic decompensation in our patient, which presented as high blood glucose levels and an increased insulin requirement.…”

Section: Discussionmentioning

confidence: 99%

The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common)

Mrozikiewicz-Rakowska

Zygmunciak

Głażewski

et al. 2021

Am J Case Rep

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Patient: Male, 57-year-old Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain Medication: Prednisone Clinical Procedure: CT scan • MRI Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Sclerosing mesenteritis is a rare disease characterized by chronic inflammation of mesenteric adipose tissue. To our knowledge, this is the first case report that presents the effects of glucocorticoid therapy on metabolic control in diabetes mellitus, aggravated by sclerosing mesenteritis. We want to show the significance of this rare disease, which could be underestimated as a cause of decompensation of diabetes mellitus. Case Report: A 57-year-old man with diabetes type 2 was admitted to the hospital to obtain better metabolic control of this disease. In addition, he reported persistent pain in the left side of his abdomen. Sclerosing mesenteritis was diagnosed based on the CT and MRI images. Prednisone was administered. The treatment resulted in better glycemic control and abdominal pain reduction. On follow-up after 1 year, the patient reported a decrease in the abdominal pain and an MRI showed a significant reduction of abnormalities in the mesentery. Conclusions: It is known that glucocorticoids exacerbate hyperglycemia, particularly in patients with diabetes mellitus. However, we noticed contrary effects in the case of our patient. We suggest that the inflammatory process occurring in sclerosing mesenteritis was one of the main causes of metabolic decompensation in our patient. The effect of reduction of inflammation with glucocorticoids was stronger than the hyperglycemic effect of this treatment. That is why, in the presence of this autoimmune disease, the use of glucocorticoids can paradoxically lead to better glycemic control.

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Section: Discussionmentioning

confidence: 99%

The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common)

Mrozikiewicz-Rakowska

Zygmunciak

Głażewski

et al. 2021

Am J Case Rep

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“…Non-specific symptoms or even absence of abnormal physical or laboratory findings at the initial presentation make the diagnosis of tumor torsion challenging [ 10 ]. Other differential diagnoses similar to this presentation include testicular torsion, torsion of testicular appendage, ovarian torsion, epiploic appendagitis, omental infarct, and sclerosing mesenteritis [ 11 , 12 ]. In most cases, plain abdominal radiographs have little or no diagnostic value.…”

Section: Discussionmentioning

confidence: 99%

Torsion of a Giant Antimesenteric Lipoma of the Ileum: A Rare Cause of Acute Abdominal Pain

et al. 2017

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Patient: Male, 67Final Diagnosis: Torsion of a giant antimesenteric lipoma of the ileumSymptoms: Acute abdomenMedication: —Clinical Procedure: En bloc segmental resection with end-to-end anastomosisSpecialty: SurgeryObjective:Rare diseaseBackground:Torsion of an intra-abdominal lipoma is rarely the cause of acute abdominal pain. Most of the previously reported cases of intra-abdominal lipoma torsion originated in the mesentery or omentum. However, an antimesenteric lipoma of the ileum with torsion has not been reported before.Case Report:A 67-year-old man presented to the emergency department with acute abdominal pain. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis only showed a giant fat-containing, soft-tissue, intra-abdominal tumor, suspected to be a lipoma. Laparotomy was performed, and the presence of torsion of the antimesenteric lipoma of the ileum was confirmed. Beside tumor resection, en bloc segmental resection of the ileum with end-to-end anastomosis was performed to avoid bowel stricture and obtain tumor-free margins.Conclusions:CECT is the modality of choice to detect an intra-abdominal lipoma. Urgent surgical intervention should be considered if the symptoms persist and torsion cannot be excluded. If simple excision is not adequate because of poor accessibility of the tumor stalk, en bloc segmental resection with end-to-end anastomosis should be considered.

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“…The association between sclerosing mesenteritis and diabetes mellitus has been described in the literature [ 15 ]. Histologically, sclerosing mesenteritis is characterized by fat degeneration and necrosis, chronic inflammation, fibrosis, and macrophages infiltration [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus is an inflammatory disease, and in obese patients with insulin resistance, adipocyte necrosis and increased numbers of macrophages in adipose tissue are also present [ 16 ]. In a recent case series of 5 patients with sclerosing mesenteritis, all patients had diabetes mellitus [ 15 ]. Thus, it can be postulated that sclerosing mesenteritis and diabetes mellitus share a similar inflammatory process involving the fatty tissue.…”

Section: Discussionmentioning

confidence: 99%

Sclerosing Mesenteritis Causing Chylous Ascites and Small Bowel Perforation

Lim

Sultan

2017

Am J Case Rep

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Patient: Male, 80Final Diagnosis: Sclerosing mesenteritisSymptoms: Abdominal distension • abdominal tendernessMedication: —Clinical Procedure: ParacentesisSpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Sclerosing mesenteritis (SM) is a rare idiopathic inflammation and fibrosis of the mesentery. Its etiology and pathogenesis remain unclear. It has been linked to abdominal trauma related to peritoneal dialysis, recent abdominal surgery, idiopathic inflammatory disorder, paraneoplastic syndrome, ischemia/infection, and autoimmunity. Abdominal CT is the most sensitive imaging modality, and diagnosis is usually confirmed by surgical biopsy. Patients most often present with abdominal pain, nausea, vomiting, diarrhea, and weight loss, and less commonly with chylous ascites and small bowel obstruction. Treatment is usually supportive; surgical intervention may be attempted for life-threatening complications such as bowel obstruction or perforation.Case Report:This report describes an 80-year-old man with hypertension and end-stage renal disease (ESRD) presenting with increasing abdominal pain and tenderness over the past 5 months. Abdominal enhanced computed tomography (CT) revealed a fat-ring sign and peritoneal calcifications along the serosa surface of small bowel consistent with sclerosing mesenteritis. His hospital course was complicated by increasing ascites requiring multiple ultrasound-guided paracentesis, worsening leukocytosis, and persistent hypotension after dialysis, requiring pressor support. Ascitic fluid analysis was consistent with chylous ascites. The patient subsequently developed small bowel obstruction causing focal perforation, leading to the death of our patient. In this report, we review the clinical presentation, radiographic findings, treatment, and outcome in our patient and review the relevant literature.Conclusions:Diagnosis of sclerosing mesenteritis is challenging due to its nonspecific clinical features. Sclerosing mesenteritis is a debilitating albeit self-limiting disorder that can rarely become fulminant, largely due to its complications.

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Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series

Cited by 14 publications

References 18 publications

The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common)

The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common)

Torsion of a Giant Antimesenteric Lipoma of the Ileum: A Rare Cause of Acute Abdominal Pain

Sclerosing Mesenteritis Causing Chylous Ascites and Small Bowel Perforation

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