A man in his 60s presented with constipation, anal pain, and hematochezia. Contrast-enhanced computed tomography showed circumferential wall thickening of the sigmoid colon with marked inflammatory changes in the surrounding mesenteric fat. Barium enema demonstrated a poorly distensible circumferential stenosis of the sigmoid colon. Colonoscopy one month before referral revealed diffusely edematous mucosa with low-profile cobblestone-like elevations, whereas repeat colonoscopy showed well-demarcated ulcerations suggestive of secondary ischemic changes. Conservative management, including fasting and systemic corticosteroid therapy, failed to improve symptoms or imaging findings. Owing to persistent stenosis and refractory symptoms, surgical resection was performed. Histopathological examination revealed diffuse submucosal panniculitis and scattered erosion, suggestive of secondary ischemic mucosal changes. Although the initial endoscopic findings were not diagnostic, serial endoscopic changes clarified progression. This case highlights the importance of assessing treatment response and imaging findings when determining surgical timing in refractory mesenteric panniculitis.
Ueha et al. (Fri,) studied this question.