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Sclerosing mesenteritis

Lawrence S Friedman, MD
Darrell Pardi, MD, MS
Section Editor
J Thomas Lamont, MD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Sclerosing mesenteritis is a rare, non-neoplastic inflammatory and fibrotic disease that affects the mesentery. Sclerosing mesenteritis can affect the integrity of the gastrointestinal lumen and mesenteric vessels by a mass effect. Sclerosing mesenteritis can result in a variety of gastrointestinal and systemic manifestations, including abdominal pain, nausea and vomiting, diarrhea, weight loss, and fever [1-4]. This topic will review the epidemiology, etiology, clinical manifestations, diagnosis, and management of sclerosing mesenteritis.


Sclerosing mesenteritis is often used as an umbrella term for a spectrum of idiopathic primary inflammatory and fibrotic processes that affect the mesentery [5,6]. Several terms have been used to describe this process based on the degree of inflammation and fibrosis, these include mesenteric lipodystrophy (with a predominance of fat necrosis) and sclerosing mesenteritis or mesenteric fibrosis (with a predominance of fibrosis) (table 1). Patients usually have a range of pathologic findings, with varying components of inflammation, fibrosis, and fat necrosis, although usually one feature predominates at a given time. Histologic progression has only rarely been documented [7]. It is quite likely that these features represent different points in the natural history of the underlying process, with adipocyte necrosis (mesenteric lipodystrophy) evolving into a chronic inflammatory state (mesenteric panniculitis), and finally to fibrosis (sclerosing mesenteritis).


Sclerosing mesenteritis appears to be rare, and a significant proportion of patients are asymptomatic. In one autopsy series, the prevalence of sclerosing mesenteritis was one percent [8]. In a prospective evaluation of over 7000 consecutive abdominal computed tomography examinations, the prevalence of sclerosing mesenteritis was 0.6 percent [9]. Most patients in this study were Caucasian. Although sclerosing mesenteritis has been reported in persons as young as three years of age, it is diagnosed most commonly in the fifth to seventh decades of life, with a median age of 65 years [10,11]. The low prevalence in childhood and adolescence may be attributable to a smaller amount of mesenteric fat [12]. While most studies have found that the prevalence of sclerosing mesenteritis is higher in men, this has not been consistently demonstrated [6,9-11]


The pathogenesis of sclerosing mesenteritis remain unclear, although several mechanisms have been postulated.

Abdominal surgery or abdominal trauma – It is hypothesized that sclerosing mesenteritis results in genetically predisposed individuals who have abnormal responses to healing and repair of connective tissue in response to trauma [6,13]. In a systematic review of the published literature, previous abdominal surgery or abdominal trauma was described in almost 30 percent of patients [11]. In one series of 92 patients with sclerosing mesenteritis, 38 patients (41 percent) had prior abdominal surgery, including cholecystectomy, appendectomy, hysterectomy, and colectomy [10]. Sclerosing mesenteritis has been reported in association with both acute abdominal injury and chronic repetitive trauma (eg, pneumatic jackhammer) and inflammation (eg, occult ileal perforation) [14,15]. The use of powdered surgical gloves has also been implicated in the development of abdominal fibrosis as a precursor to sclerosing mesenteritis [10].

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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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