CASO CLÍNICO DE PANICULITE MESENTÉRICA ASSOCIADA A GASTRITE CRÓNICA E LITÍASE BILIAR–DIAGNÓSTICO, TERAPÊUTICA E MORBILIDADE | CLINICAL CASE OF MESENTERIC PANNICULITIS ASSOCIATED WITH CHRONIC GASTRITIS AND BILIARY LITHIASIS–DIAGNOSIS, TREATMENT & MORBIDITY
Resumo
PT:
RESUMO
A paniculite mesentérica é uma doença inflamatória crónica fibrosante, rara, que afecta o tecido adiposo do mesentério. A
sua etiologia é desconhecida e a apresentação clínica variável, o que torna o diagnóstico particularmente difícil, sendo habitualmente sugerido por tomografia computorizada e confirmado por biópsia. O tratamento é essencialmente empírico, médico (incluindo corticóides) ou cirúrgico. Apesar de ter, geralmente, um curso benigno, pode estar associada a morbilidade significativa.
Apresentamos o caso de uma doente de 84 anos, internada por estado confusional agudo, dor abdominal difusa, recusa
alimentar e vómitos pós-prandiais. Ao exame objectivo, sem alterações valorizáveis, além da dor à palpação abdominal. A
investigação subsequente revelou a existência de anemia perniciosa, gastrite crónica, angiodisplasia duodenal e também
paniculite mesentérica,
Após 2 meses medicada com prednisolona 40 mg/dia, verificou-se resolução sintomática e imagiológica. Infelizmente, a
doente veio a falecer na sequência de pneumonia associada aos cuidados de saúde.
Palavras-chave:Paniculite mesentérica; gastrite crónica; litíase biliar; tomografia computorizada; corticóides
EN:
ABSTRACT
The mesenteric panniculitis is a rare chronic inflammatory fibrosing disease that affects the mesentery’s adipose tissue. Its aetiology is
unknown and it has several clinical presentations, which lead to a particularly difficult diagnosis. The diagnosis is normally suggested by
computer tomography and confirmed by biopsy. The treatment is mainly empiric, medical (including corticosteroids) or surgical. Despite having usually a benign course, it may be associated with significant morbidity.
We present the case of an 84-year-old female patient, admitted for delirium, diffuse abdominal pain, food rejection and postprandial
vomiting. At physical examination, there were no substantial abnormalities, aside from abdominal tenderness. Further investigation revealed
the existence of pernicious anaemia, chronic gastritis, duodenal angiodysplasia and mesenteric panniculitis.
After 2 months treated with prednisolone 40 mg per day, there was symptomatic and radiological resolution. Unfortunately, the patient
died as a result of healthcare-associated pneumonia.
Key Words: Mesenteric panniculitis; Chronic gastritis; Biliary lithiasis; Computed tomography; Corticosteroids
Texto Completo:
PDFReferências
Issa I, Baydoun H. Mesenteric panniculitis: various presentations and treatment regimens. World J Gastroenterol. 2009; 15: 3827-30.
Gu G, Wang S, Wei X, Ren L, Li D, Zou F. Sclerosing mesenteritis as a rare cause of abdominal pain and intraabdominal mass: a cases report.
Cases J. 2008; 1: 242.
Akram S, Pardi DS, Schaffner JA, Smyrk TC. Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin
Gastroenterol Hepatol. 2007; 5: 589-96.
Emory TS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity? Am
J Surg Pathol. 1997; 21: 392-8.
Plasencia LD, Ballester LR, Fernández EM, Morales AH, Pallarés AC, Siverio NH. Mesenteric panniculitis: experience in our center. Rev Esp
Enferm Dig. 2007; 99: 291-7.
Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, et al. CT evaluation of mesenteric panniculitis:
prevalence and associated diseases. AJR Am J Roentgenol. 2000; 174: 427-31.
Cuff R, Landercasper J, Schlack S. Sclerosing mesenteritis. Surgery. 2001; 129: 509-10.
Shah AN, You CH. Mesenteric lipodystrophy presenting as an acute abdomen. South Med J. 1982; 75: 1025-6.
Ferrari TC, Couto CM, Vilaça TS, Xavier MA, Faria LC. An unusual presentation of mesenteric panniculitis. Clinics. 2008; 63: 843-4.
Moreira LBM, Pinheiro RA, Melo ASA, Alves JRD, Noro F, Marchiori E. Paniculite mesentérica: aspectos na tomografia computorizada. Radiol
Bras. 2001; 34: 135-40.
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