Sclerosing mesenteric panniculitis in a young patient : common cause of diagnostic dilemma and treatment refractoriness

Background : Sclerosing mesenteric panniculitis (SMP) is an -idiopathic-chronic-fibroinflammatory-disorder-of-the-intra-abdom- inal fat. Case presentation : Herein, we report a case of SMP, involving the- omentum,- mesentery- and- peri-colic- fat- in- a- 18- year- old- male, who-presented-with-significant-and-recurrent-abdominal-distension for 4.5 years. Computed tomogram revealed ascites, with nodular and- irregular- omental- thickening- and- foci- of- calcification.- Non- specific- radiological- and- histological- features- made- an- accurate -diagnosis-extremely-difficult.- After-a-thorough-work-up-and-exclu- sion of other differentials, diagnosis of a nodular SMP (Weber Christian disease) was given. After showing resistance to chemo- therapeutic agents, slow response was noted with cyclophospha- mide,- followed- by- rapid- symptomatic- improvement- with- mesen- terectomy. Conclusion : SMP is an uncommon benign mesenteric/ omental inflammation,-and-is-a-diagnosis-of-exclusion.-As-treatment-refrac- toriness is common, management should be individualized and continued for a long period. Surgical omentectomy may be helpful. (Acta gastroenterol. belg., 2016, 79, 254-256).