History and admission findings: A 22-year-old man who had never been seriou
sly ill previously was admitted because of epigastric pain and vomiting of
bile.
Investigations: He had slight pain on pressure over the epigatric region an
d decreased intestinal peristaltic sounds. There was evidence of ileus of t
he small intestine both by ultrasound and radiologically.
Treatment and course: As the patient's condition deteriorated on conservati
ve treatment, an exploratory laparotomy was performed. It revealed an invag
inated Meckel's diverticulum. Ileus of the small intestine recurred postope
ratively, requiring relaparotomy. A glued-together volvulus of the small in
testine had to be resected, even though there was no sign of an anastomotic
leak. But there was no postoperative improvement. A third operation reveal
ed a clearly shortened and 3 cm-thick mesentery which showed a stage III re
tractile mesenteritis. Histological reexamination of the specimens resected
at the previous operations revealed stage I and II retractile mesenteritis
. The patient's condition slowly improved on high doses of corticosteroids
and he ultimately became symptom-free.
Conclusions: Retractile mesenteritis is a very rare benign disease of the m
esentery, almost always causing abdominal pain and diagnosed histologically
by exploratory laparotomy. Administration of corticosteroids is the treatm
ent of choice.