Idiopathic sclerosing mesenteritis: Difference between revisions
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==Overview== | ==Overview== | ||
'''Idiopathic sclerosing mesenteritis''' (ISM) or '''mesenteric panniculitus''' is a [[rare disease]] of the [[small intestine]], characterized by chronic [[inflammation]] and eventual [[fibrosis]] of the [[mesentery]]. | '''Idiopathic sclerosing mesenteritis''' (ISM) or '''mesenteric panniculitus''' is a [[rare disease]] of the [[small intestine]], characterized by chronic [[inflammation]] and eventual [[fibrosis]] of the [[mesentery]]. It has also been called mesenteric lipodystrophy, or retractile mesenteritis. | ||
==Historical Perspective== | |||
The Mayo Clinic in Rochester, MN, reported a large study of 92 patients, with widely ranging severity of their symptoms. The majority were male, average age 65 years. They commonly had abdominal pain (70%), diarrhea (25%) and weight loss (23%). Depending on the stage of the scarring and fibrosis, several different treatments including surgery, for bowel obstruction, or drugs were used to halt the progression of the disease. | |||
In that case series, 56% of patients received only pharmacological therapy, most often receiving [[tamoxifen]] with a reducing dose of reducing [[prednisone]], or also had [[colchicine]], [[azathioprine]] or [[thalidomide]]. | |||
Their findings suggest that sclerosing mesenteritis can be debilitating although relatively benign. Symptomatic patients benefited from medical therapy, usually tamoxifen and prednisone, but further follow-up information would strengthen these results. | |||
==Classification== | |||
==Pathophysiology== | |||
== | ==Causes== | ||
==Differentiating {{PAGENAME}} from Other Diseases== | |||
==Epidemiology and Demographics== | |||
The epidemiology of Idiopathic sclerosing mesenteritis disease is extremely rare and has only been diagnosed in about an estimated 300 patients worldwide to date (as of 2014), it is probably under diagnosed. | |||
It can occur in children. | |||
==Risk Factors== | |||
==Screening== | |||
==Natural History, Complications, and Prognosis== | |||
===Natural History=== | |||
===Complications=== | |||
===Prognosis=== | |||
==Diagnosis== | |||
===Diagnostic Criteria=== | |||
===History and Symptoms=== | |||
===Physical Examination=== | |||
Sclerosing mesenteritis may present with no or nearly no signs or symptoms, but many people have chronic and severe pain in the abdomen as the most common [[chief complaint]]. Other people have chronic problems with bowel movements, resulting in diarrhea, bloating, gas, and cramping which can range from severe to mild. | |||
The disorder is identified by histopathology showing fat necrosis, fibrosis and chronic inflammation of the small intestine. Examination of the mesentery may indicate a solitary mass, but diffuse mesentery thickening is common. | |||
==Mechanism== | ==Mechanism== | ||
Several causes of sclerosing mesenteritis have been suggested, but the principal pathophysiological mechanism is probably autoimmune. Trauma and prior surgical procedures have also been indicated as possibilities. | Several causes of sclerosing mesenteritis have been suggested, but the principal pathophysiological mechanism is probably autoimmune. Trauma and prior surgical procedures have also been indicated as possibilities. | ||
== | ===Laboratory Findings=== | ||
== | ===Imaging Findings=== | ||
===Other Diagnostic Studies=== | |||
==Treatment== | |||
===Medical Therapy=== | |||
===Surgery=== | |||
===Prevention=== | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | |||
{{WS}} | |||
{{WH}} | |||
Latest revision as of 19:13, 11 July 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Idiopathic sclerosing mesenteritis (ISM) or mesenteric panniculitus is a rare disease of the small intestine, characterized by chronic inflammation and eventual fibrosis of the mesentery. It has also been called mesenteric lipodystrophy, or retractile mesenteritis.
Historical Perspective
The Mayo Clinic in Rochester, MN, reported a large study of 92 patients, with widely ranging severity of their symptoms. The majority were male, average age 65 years. They commonly had abdominal pain (70%), diarrhea (25%) and weight loss (23%). Depending on the stage of the scarring and fibrosis, several different treatments including surgery, for bowel obstruction, or drugs were used to halt the progression of the disease.
In that case series, 56% of patients received only pharmacological therapy, most often receiving tamoxifen with a reducing dose of reducing prednisone, or also had colchicine, azathioprine or thalidomide.
Their findings suggest that sclerosing mesenteritis can be debilitating although relatively benign. Symptomatic patients benefited from medical therapy, usually tamoxifen and prednisone, but further follow-up information would strengthen these results.
Classification
Pathophysiology
Causes
Differentiating Idiopathic sclerosing mesenteritis from Other Diseases
Epidemiology and Demographics
The epidemiology of Idiopathic sclerosing mesenteritis disease is extremely rare and has only been diagnosed in about an estimated 300 patients worldwide to date (as of 2014), it is probably under diagnosed. It can occur in children.
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Sclerosing mesenteritis may present with no or nearly no signs or symptoms, but many people have chronic and severe pain in the abdomen as the most common chief complaint. Other people have chronic problems with bowel movements, resulting in diarrhea, bloating, gas, and cramping which can range from severe to mild.
The disorder is identified by histopathology showing fat necrosis, fibrosis and chronic inflammation of the small intestine. Examination of the mesentery may indicate a solitary mass, but diffuse mesentery thickening is common.
Mechanism
Several causes of sclerosing mesenteritis have been suggested, but the principal pathophysiological mechanism is probably autoimmune. Trauma and prior surgical procedures have also been indicated as possibilities.