A242 SCLEROSING MESENTERITIS OF THE PORTA HEPATIS PRESENTING AS CHOLANGIOCARCINOMA WITH RECURRENT CHYLOUS ASCITES AND GASTRIC OUTLET OBSTRUCTION
Bibliographic record
Abstract
Abstract Background Sclerosing mesenteritis (SM) is characterized by chronic fibroinflammatory infiltration of the abdominal mesentery. While commonly affecting the small bowel, we present the first reported case of SM mimicking hilar cholangiocarcinoma by involving the porta hepatis, resulting in chylous ascites, gastric outlet obstruction, and duodenal perforation. Aims To broaden recognition of this rare disease and expand literature on treatment options Methods Case report and literature review Results A 59-year-old man with previous alcoholic pancreatitis presented with one month of progressive abdominal pain and distension. He was found to have large volume chylous ascites and a hilar mass on computed tomography scan. Magnetic resonance cholangiopancreatography confirmed a soft tissue density at the porta hepatis with intra- and extrahepatic duct dilation. Endoscopic ultrasound (EUS) revealed a soft tissue mass and biopsies showed a chronic lymphohistiocytic infiltrate but no malignancy. Positron emission tomography, liver biopsy, and bidirectional endoscopy were unrevealing. Serial large-volume paracenteses were performed for comfort, though portal hypertension was ruled out via transjugular measurements. One month into hospitalization, he developed gastric outlet obstruction from extrinsic mass and required nasojejunal feeding. This was complicated by a contained duodenal perforation managed non-operatively. Palliative dexamethasone was started for presumed cholangiocarcinoma which entirely resolved his symptoms. He was discharged after three months but represented off steroids with recurrent ascites and gastric outlet obstruction. Diagnostic laparoscopy was negative. EUS-guided biopsy again showed the same chronic inflammatory infiltrate. He was diagnosed with SM and started on oral prednisone which resolved his symptoms. He remains in remission as an outpatient on colchicine, tamoxifen, and low-dose prednisone. Conclusions SM is a rare disease characterized by chronic mesenteric inflammation, fibrosis, and fat necrosis. While 10% of cases are incidental findings, complications occur in 24% of patients and include recurrent chylous ascites, small bowel obstruction, and intestinal perforation. Diagnosis is challenging given non-specific findings but can be made on histology and radiology. This benign disease is often mistaken for malignancy, resulting in unnecessary diagnostic tests. To our knowledge, this is only the second reported case of hilar SM, and the first to present with the aforementioned complications. Treatment includes prednisone and tamoxifen, with colchicine, azathioprine, or thalidomide used as steroid-sparing agents. Increased recognition of this entity will help avoid unnecessary diagnostic interventions and inform options for medical therapy. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".