Abdominal Pain and Weight Loss

In our experience, three of 92 patients (3%) died from causes that were thought to be attributable to sclerosing mesenteritis or its treatment.10,11

In summary, sclerosing mesenteritis is a rare disease entity that thickens and shortens the mesentery due to a non-specific fibroinflammatory reaction in the mesentery. Diagnosis relies on CT scanning and tissue biopsy, which shows variable degrees of fibrosis, chronic inflammation, and fat necrosis. Treatment options are based on anecdotal experience only. Tamoxifen, with or without combination therapy with prednisone, colchicine, azathioprine, and thalidomide, appears to be of some benefit. Prognosis is variable, with some patients achieving remission while others die from complications related to disease progression such as bowel obstruction, mesenteric vascular occlusion, and malnutrition; however, many have persistent symptoms that may improve but not resolve with medical therapy. TH

References

1. Kelly JK, Hwang WS. Idiopathic retractile (sclerosing) mesenteritis and its differential diagnosis. Am J Surg Pathol. 1989;13(6):513-521.
2. Emory TS, Monihan JM, Carr NJ, et al. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity? Am J Surg Pathol. 1997 Apr;21(4):392.
3. Durst AL, Freund H, Rosenmann E, et al. Mesenteric panniculitis: review of the literature and presentation of cases. Surgery. 1977;81:203.
4. Chew CK, Jarzylo SV, Valberg LS. Idiopathic retroperitoneal fibrosis with protein-losing enteropathy and duodenal obstruction successfully treated with corticosteroids. Can Med Assoc J. 1966;95(23):1183-1188.
5. Clark CP, Vanderpool D, Preskitt JT. The response of retroperitoneal fibrosis to tamoxifen. Surgery. 1991 Apr;109(4):502-506.
6. Owens LV, Cance WG, Huth JF. Retroperitoneal fibrosis treated with tamoxifen. Am Surg. 1995;61:842-844.
7. Venkataramani A, Behling CA, Lynche KD. Sclerosing mesenteritis: an unusual cause of abdominal pain in an HIV-positive patient. Am J Gastroenterol. 1997 Jun;92(6):1059-1060.
8. Genereau T, Bellin MF, Wechsler B. Demonstration of efficacy of combining corticosteroids and colchicine in two patients with idiopathic sclerosing mesenteritis. Dig Dis Sci. 1996;41(4):684-688.
9. Andersen JA, Rasmussen NR, Pedersen JK. Mesenteric panniculitis: a fatal case. Am J Gastroenterol. 1982 Jul;77(7):523-525.
10. Akram S, Pardi DS, Smyrk TC. Sclerosing mesenteritis: The Mayo Clinic Experience. (Clinical features and tx response) Gastroenterology. 2003;A-190.
11. Akram S, Pardi DS, Smyrk TC. Effect of tamoxifen on clinical course of sclerosing mesenteritis. Gastroenterology. 2006;130:A-322.
12. Ginsburg PM, Ehrenpreis ED. A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis. Aliment Pharmacol Ther. 2002 Dec;16(12):2115-2122.

Historic Puzzler #3: The Root of the Problem

In 1777 G.F. was traveling through the South Pacific Islands as a naturalist. He witnessed a ceremony that involved a substance being “ … made in the most disgustful [sic] manner that can be imagined, from the roots of a species of pepper-tree. The root is cut small and the pieces chewed by several people, who spit the macerated mass into a bowl. … They strain it through a quantity of fibers … and mix with the coconut milk. They swallow this nauseous stuff as fast as possible; and some old topes value themselves on being able to empty a great number of bowls.”

Who was GF, the captain of this expedition, and what was the root?

Recent reports suggest possible hepatotoxicity from this substance. For extra credit, what are the dermatologic and neuro-ophthalmologic side effects of chronic heavy ingestion?