Research progress in hardened mesentericitis

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Research progress in hardened mesentericitis

2021-11-24 23:57:22 14 ℃

Meng Xinying

Qingdao Municipal Hospital (Dongyuan District) Health Care

Sclerosing Mesenteritis (SM) is a rare, mainly involved chronic fibroitis symptomatic lesion of mesenteric adipose tissue, mostly in the small intestine membrane, and a few can be seen in coliform or large reticulum. At present, the SM cause is not clear, and the clinical manifestations are not specific, mainly due to the abdominal CT diagnosis. Most patients have a slight symptom without treatment, and patients with a few symptoms or complications are actively intervene. This paper summarizes the research progress related to hardened intestinal membrane inflammation to improve the understanding of this rare disease.


In 1924, JURA describes the disease in a contractual mesenteritis (Retractile Mesenteritis), which has occurred in MSenteric Panniculitis (MP), mesenteric lipodystrophy, ml), intestinal membrane fat granulation LIPOGRANULOMA of the mesentery, Isolated Lipodystrophy and Retroperitoneal Xanthogranulima, intestinal Weber Christian disease, etc. [2].

Enteric fat malnutrition, mesenteric liposome, shrinkable mesentericitis is considered to be the three different stages of this disease, respectively correspond to relatively specific pathological changes, namely fat necrosis, mesenteric chronic inflammation, and fibrosis. In 1997, Emory et al. Reviewed 84 cases of intestinal ml, MP, systolic mesenteric inflammation and SM, graded fibrosis, inflammation, and fatty necrosis. The results showed that all patients have different degrees of fibrosis, chronic inflammation, and fatty necrosis. In most patients, the above three ingredients are highly mixed so that they cannot be clearly separated. Fibrosis is the most consistent pathological characteristics of this disease [3]. Since there are scholars recommend using SM's summary terms to describe diseases such as fibrosis [4].

2. Cause

This disease is still not clear. Currently known to SM consolidation include abdominal injury and surgical history, infection, mesenteric ischemia and idiopathic inflammation (such as peritoneal fibrosis, hardened cholangitis, Riedel thyroiditis, eyelid fake tumor), autoimmunity Sexual disease (dry syndrome, IgG4 relevance disease), malignant tumor, etc. [5-7]. A study retrospectively analyzed 192 SMs, found that common combined lesions were previous surgery (28.6%), malignant tumors (8.9%) and autoimmune diseases (5.7%) [8]. Due to lack of control research, the correlation between these lesions and SM has no conclusion.

The relationship between SM and malignant tumors still has controversy. A number of cases were found that the incidence of malignant tumors in SM was 50% to 74.8%, higher than 35.2% to 59.4% of the control group, and more common is lymphoma, melanoma and prostate cancer [9-11] . However, in the study of age, gender matching, the incidence of SM combined tumors is similar to the control group, or only slight statistical differences [12]. A queue study for 13 years of follow-up shows that the mitigation rate of MP is not related to whether or not the malignant tumor and whether malignant tumors are treated [13]. Therefore, it is considered that SM is not a subcarcically phenomenon, and the higher tumor incidence in SM may also be multi-abdominal imaging examination with malignant tumors, which is more likely to find SM.

The relationship between SM and IgG4-associated disease (IgG4 Related Diseses, IgG4-RD) is also unclear. It is reported that SM is the performance of the IgG4-Rd accumulated intestinal membrane, and there is also a report that SM and IgG4-RD are two independent diseases. The difference between these two views is whether SM is in line with IgG4-RD diagnostic criteria, that is, high serum IgG4 levels, tissue IgG4 elevation, multi-organ accumulation and effectiveness of glucocorticoid therapy, if it is in line with IgG4 Related SM [14]. Histracy is similar, but does not meet the diagnostic criteria of IgG4-RD, it is considered that SM and IgG4-RD are independent of [15, 16].

3. The incidence and clinical manifestations

The disease is rare, the prevalence is 0.18% to 3.14%, and more than a retrospective analysis of abdominal images [10,17]. This disease is good in middle-aged and elderly people, with an average age of 60 years old, and the 60-70 years old reaches the peak. The proportion of men and women is 2 ~ 3: 1 [9, 13]. Although children have reports, it is rare, it may be less related to children's intestinal membrane adipose tissue, so far, only more than 20 cases, the smallest patient is 5 months of baby girl, with abdominal pain, vomiting, and abdominal fluid, ultimately The organizational biopsy was confirmed to be a disease [18,19].

SM symptoms and signs are unfitable. The most common symptoms are abdominal pain, with 78.1% of patients, others are fever (26%), weight loss (22.3%), diarrhea (19.5%), vomiting (18.2%), anorexia (13.5%), constipation ( 10.9%), bloating (9.4%), discomfort (5.7%), nausea (5.7%), eating pain (4.7%), fatigue (2.1%). When the subject, 38% of patients may have abdominal tenderness, 34.4% can touch the abdominal block, about 15.1% visible abdominal expansion [4, 8]. Sometimes it is difficult to identify the symptoms of accompanying diseases. It has been reported that the gallbladder resection has no relief after abdominal pain, and it is found to be SM, and the symptoms of SM are mitigated after treatment [20]. A small number of patients are complicated or severely combined with diseases. The most common is intestinal obstruction and / or perforation [7,21], and there are also multi-slurry cavity liquid [22], chyamic abdominal water [23], protein loss Strue disease [24], etc., eventually organized to confirm the disease. A small number of SM can develop rapid progress, which is shown in laparoscopic submergengectomy [25], laparoscopic intestinal obstruction [26] and the new auxiliary chemotherapy of near-end gastric cancer after 3 cycles [27], progressive progression The relationship between surgery or chemotherapy is still not clear.

Laboratory examination is also specifically, common with red blood cell settlement or C-reactive protein is elevated, seen in 16% and 25% of patients with 16% and 25%, 5% of patients with 14% to 88%, with anemia, 5% of patients with low protein Temples [4,28]. In the case of combining autoimmune diseases, it may have a positive antibody, such as anti-nuclear antibody, anti-dried syndrome antibody, anti-histone antibody [28, 29].

4. Diagnostics

The diagnosis of this disease mainly rely on imaging, CT is the most valuable diagnostic method. Common reasons for accepting CT exams have a suspected malignant tumor or tumor follow-up (50% ~ 70%), find abdominal pain reasons (15% ~ 27%), other infection, vascular disease or inflammatory bowel disease follow-up [ 10, 30]. Most cases can be diagnosed directly from CT without biopsy. The CT representation of the SM includes an intestinal mass that exhibits a placement effect. The fat density in the mass is uneven (CT value in -50Hu ~ -70Hu), the intestinal film [31, 32], these imaging symbols are also to be edema and bleeding, Identification of diseases such as lymphoma, metastatic tumor, category, peritoneal fibrosis [33].

Mr helps to find the fibrosis ingredient in the SM lesion, which can be supplemented as a CT examination. The fibrous lesions in the MRI clay showed uneven length T1, long T2 signal, and the fake package film is equal to T1, short T2 signal [33, 34]. The high intake of 18F-deoxyl glucose (FDG) in PET-CT is one of the main points of the intestinal tumor disease and SM [35]. However, some pathologically confirmed that the intestinal mass of SM also has a higher FDG taken value, the maximum standard take-up value (SUVMAX value) is 1.6 ~ 19.06 [29, 36], so it is not possible to distinguish the nature of the intestinal membrane, such as when It is found that lymphadenopathy outside the intestinal membrane is large, the splenome, the spleen and bone marrow have a high metabolism, and the possibility of tumors, especially lymphoma is highly suggested [37]. The main significance of PET-CT is to prompt the biopsy of the biopsy of the high FDG ingestion lesions for diagnosis.

Although historics is a diagnosed gold standard, it is necessary to use invasive inspection methods. Therefore, in a small number of cases, such as mesenteric lymph nodes greater than 10 mm or PET-CT examination, high intake masses cannot be identified with malignant tumors. Coaxial puncture biopsy technology under mirror or CT guided tissue specimens [38].

5. Treatment and follow-up

Most patients without symptomatic or symptoms do not need treatment. Antibiotics or non-steroidal anti-inflammatory drugs can be used to relieve abdominal pain. A study from Turkey shows that antibiotics (including cephalosporin, quinolones, amoxicillinlavi-free) and non-steroidal anti-inflammatory drugs are given in a short time [17] .

SM patients with severe symptoms, in the clear symptoms, can be preferred after SM, can prefer glucocorticoids combined with him Moshen treatment. It is recommended to use the Predmy 40mg / d combined with him Moshifen 10mg BID, use for at least 4 months, most patients have improved during this period. If effective, the amount of glucocorticoids can be gradually reduced, and he will continue to use him Moshen. This protocol should be fully informed of the adverse reactions of the patients in patients before use. Other immunosuppresses should be prevented in the use of other immunosuppresses when using this scheme.

Sali amines are also used to treat SM. So far only one forward-looking study believes that the Sandli amine is effective, and the use method is the Sandy amine 200 mg QN for 12 weeks. In addition to 1 case, there was a surrounding neuropathy in the 46th week, and the remaining unveiled adverse reactions [39]. The same team attempts to use small doses of Nalcone to treat SM in 2015 in 2015. Narcone is an opioid antagonist with an immunomodulatory effect. The dose was reported to use a dose of 4.5 mg Qn for 12 weeks, but the open label test was only incorporated in 3 patients. The efficacy has not been confirmed [40].

Surgery is mainly used for treatment and relieving complications. Inflammation and fibrosis can cause extensive adhesion to the surrounding tissue, completely cutting of intestinal lesions, must fully evaluate the risk of surgery, generally adopt a palliative style, such as bypass surgery, resection of ischemic small intestine or adhesion Stripping [41].

The treatment effect is more symptoms as a judgment criterion, and hematology indicators are restored to normal and the intestinal membrane lesions are reduced or saved as a reference standard. Due to the stability of most patients, there is generally no regular follow-up. It is reported that regular follow-up can avoid malignant diseases, but have not been verified by most studies, and there is no consensus for a long time, and there is no consensus [9, 30, 42].

In summary, SM is a non-specific, benign mesenteric chronic fibroitis symptomatic lesion, most patients are lighter, the clinical process is stable, no treatment, good prognosis. A small number of patients have obvious symptoms or serious complications need to be actively intervened. With the increase in disease cognition, the disease between this disease, imaging, and clinical characteristics can be further introduced to better guide clinical practice.

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