蔡佳宏¹、康智雄¹

高雄長庚紀念醫院 泌尿科¹

Chia-Hung Tsai¹, Chih-Hsiung Kang ¹

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan¹

 

Mesenteric panniculitis is a rare disease of chronic inflammation of mesenteric fat. The most common symptom is the lower back, abdominal or flank pain. Some patients may have coexisted malignancy such as prostatic carcinoma. We present a rare case that suffered from bilateral hydronephrosis and hematuria due to mesenteric panniculitis.

  A 38-year-old man presented to the emergency department with a 3-day history of progressively lower abdominal pain and hematuria. Physical examination revealed lower abdominal tenderness without rebounding pain. Laboratory studies revealed microcytic anemia, acute kidney injury. Urine routine exam revealed hematuria. Computed tomography of the abdomen found bilateral obstructive hydronephrosis due to misty mesentery of the lower abdomen and mesenteric fat stranding in the pelvic capacity. Cystoscopy showed diffuse bladder mucosa swelling and erythematous change. Panendoscopy showed a gastric mass over high body fundus. Consequently, the results of both pathological testing were adenocarcinoma. It proved that bladder cancer was a metastasis from gastric cancer. After diagnosed with metastatic gastric cancer, the patient underwent jejunostomy and received adjuvant chemotherapy. Bilateral percutaneous nephrostomy was inserted for obstructive uropathy

  The fat-ring sign, a manifestation of mesenteric panniculitis, refers to the preservation of normal fat density in the fatty tissue surrounding the mesenteric vessels. It should be diagnosed with mesenteric inflammation, hemorrhage, edema, lymphedema, and neoplasm. The patient may suffer from tenderness or other symptoms including weight loss, nausea and vomiting, and fever. However, the intriguing point of this case is performed with bilateral hydronephrosis and hematuria. Accurate diagnosis and survey might help the patient receive accurate treatment.