Young man with abdominal pain and right-sided abdominal fullness

Description

A 26-year-old man presented with a 5-day history of persistent central and right-sided dull abdominal pain with no associated symptoms. He had, at the age of 3 years, undergone a Duhamel procedure for Hirschsprung's disease. On presentation, he was in no pain and his vital signs were normal. There was right iliac fossa fullness with tenderness, guarding and rigidity. Routine blood tests including C reactive protein were normal. Acute abdominal series showed mild gaseous distension but no air fluid levels. Abdominal CT scan (figure 1) revealed diffuse stranding in the small bowel mesentery, with multiple lymph nodes and irregularly dilated venous channels; suggestive of mesenteric panniculitis. The patient was treated with analgaesics and prednisolone. Abdominal symptoms and signs improved dramatically over 48 h. He was completely asymptomatic at 9-month follow-up.

Figure 1

CT scan of the abdomen ((A) axial view, (B) sagittal view) showing diffuse stranding...

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