Other nonneoplastic

Sclerosing mesenteritis

Last author update: 17 February 2021
Last staff update: 10 May 2022

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PubMed search: sclerosing mesenteritis colon

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Sclerosing mesenteritis. website. Accessed February 22nd, 2024.
Definition / general
  • Uncommon nonneoplastic condition that causes thickening and shortening of colonic mesentery (JBR-BTR 2011;94:241)
Essential features
  • Benign fibrotic / inflammatory condition involving the mesentery
  • Some cases are IgG4 related
  • Older terms include idiopathic retractile mesenteritis, mesenteric panniculitis and mesentery lipodystrophy (Am J Surg Pathol 1997;21:392)
  • Affects the mesentery; small bowel mesentery is involved more often than colonic
Clinical features
Radiology description
  • Mesentery can show fat attenuation or a fibrofatty mass
Case reports
  • Various medications (including corticosteroids) and surgery, depending on clinical severity (Int Arch Med 2011;4:17)
Clinical images

Images hosted on other servers:

Thick mesentery with yellow nodules

Gross description
  • Markedly thickened and rubbery mesentery causing bowel twisting
Microscopic (histologic) description
  • Fibrosis with dense collagen, fat necrosis, chronic inflammation (especially around vessels) and variable focal calcification
  • Minimal atypia, no or few mitoses
  • IgG4 related cases lack fat necrosis and show obliterative phlebitis and increased inflammation
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Fibrosis and chronic inflammation

Fibrosis and chronic inflammation, high power

Fibrosis, chronic inflammation and fat necrosis

Images hosted on other servers:

Fat necrosis, sclerosing fibrosis, chronic inflammation

Fat necrosis with numerous lipid laden macrophages

Positive stains
  • IgG4 (in some cases)
Negative stains
Sample pathology report
  • Transverse colon and mesentery, excision:
    • Prominent bland fibrotic process involving mesentery (see comment)
    • Segment of colon with reactive change.
    • Negative for malignancy.
    • Margins of resection unremarkable.
    • Comment: The overall findings are most consistent with sclerosing mesenteritis.
Differential diagnosis
Board review style question #1

Which of the following is true about sclerosing mesenteritis?

  1. IgG4 immunohistochemistry will always highlight numerous plasma cells
  2. It is a neoplastic process
  3. It is common in the pediatric population
  4. Treatment can involve medication rather than surgery
Board review style answer #1
D. Treatment can involve medication rather than surgery

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Reference: Sclerosing mesenteritis
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