# Gouty Tophus in the Small Bowel Mimicking a Calcifying Mesenteric Mass

## TL;DR

This case report describes a rare instance of gouty tophus in the small bowel, mistaken for a calcifying mesenteric mass.

## Contribution

The paper presents an extremely rare case of gouty tophus in the small intestine mesentery, highlighting its diagnostic challenge.

## Key findings

- A large calcified mesenteric mass was found to be a gouty tophus in an 80-year-old woman.
- Histological analysis confirmed the presence of monosodium urate crystals and dystrophic calcifications.
- The case emphasizes the need to consider gout in patients with hyperuricemia and unexplained abdominal masses.

## Abstract

Gout is a common metabolic disorder caused by hyperuricemia, which results in the deposition of monosodium urate crystals in various parts of the body. In the present case, a large gout tophus was detected based on gout disease. Although gouty tophi might occur in many locations during a long-standing gout disease, the vast majority are located in the articular tissue. An 80-year-old female patient was admitted to the emergency room complaining of persistent nausea and vomiting for two days. In addition, she reported abdominal pain and cramps that she had not experienced before. A CT scan revealed a large calcified mesenteric mass in the right side of the abdomen. The patient underwent surgery and removal of the mesenteric mass including 55-cm jejunal resection. Histologically, sections showed a capsule-like boundary of varying widths, mostly cell-poor lesions, as well as siderophages and strong lymphatic infiltrate at the margins, corresponding to residual lymph node tissue. In the periphery of the lesion, brace-shaped dystrophic calcifications completed the histological image of a gouty tophus. In this case report, we describe an extremely rare case of a mass in the area of the small intestine mesentery caused by monosodium urate crystals. Even if patients do not present with articular manifestation of gout, deposition in other tissues is possible and presents a risk factor for the development of diseases. For patients with unclear abdominal masses suffering from hyperuricemia, despite being rare, a gout tophus should be thought of.