# Sclerosing Mesenteritis Presenting With Small Bowel Obstruction in a Patient With Systemic Lupus Erythematosus: A Case Report

## TL;DR

A rare case of sclerosing mesenteritis causing small bowel obstruction in a patient with systemic lupus erythematosus is reported, highlighting diagnostic and management challenges.

## Contribution

This case report adds to the limited literature on sclerosing mesenteritis in the context of systemic lupus erythematosus and small bowel obstruction.

## Key findings

- A 78-year-old male with systemic lupus erythematosus presented with acute abdominal pain and small bowel obstruction due to sclerosing mesenteritis.
- Histopathological examination confirmed subserosal fibrosis and chronic inflammation consistent with sclerosing mesenteritis.
- The case underscores the difficulty in diagnosing and managing small bowel obstruction in patients with sclerosing mesenteritis and autoimmune conditions.

## Abstract

Sclerosing mesenteritis (SM) is a rare inflammatory disorder characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue. While SM can manifest with various gastrointestinal symptoms, its association with small bowel obstruction (SBO) is infrequent. We present a case of a 78-year-old male with a history of systemic lupus erythematosus (SLE) who presented with acute abdominal pain and distention. The patient had multiple admissions with the same symptoms. A CT scan showed swirling of the proximal central mesentery, small bowel malrotation with volvulus, and high-grade mechanical obstruction of the proximal jejunum. The patient underwent exploratory laparotomy, with findings significant for multiple inflammatory nodules in the mesentery. These were causing adhesions between the bowel and mesentery, resulting in a volvulus of the bowel. One segment was resected, and subsequent histopathological examination revealed subserosal fibrosis and chronic inflammation. The clinical scenario was consistent with a diagnosis of SM. This case highlights the challenges of diagnosing and managing SBO in the presence of SM and SLE. Further research is needed to understand the underlying pathophysiological mechanisms and improve management techniques for this rare clinical condition.