A Rare Case of Retroperitoneal Fibrosis involving the Superior Mesenteric Artery causing Mesenteric Angina

Introduction Retroperitoneal fibrosis (RPF) is an uncommon condition in which a fibrotic and inflammatory mass envelops and potentially obstructs retroperitoneal structures, including either or both ureters. Extension of the retroperitoneal plaque to involve the superior mesenteric artery (SMA) is rare and to the best of the author's knowledge this is the first reported case of mesenteric angina due to RPF. Case presentation We report the case of a lady with retroperitoneal fibrosis resulting in obstructive uropathy, who was initially managed with ureterolysis, omental wrapping and medical therapy (steroids and Tamoxifen).She improved with the above management However, over the courseof 12 months, her disease progressed and she presented with complaints of persistent post prandial upper abdominal pain. The repeat CECT abdomen and pelvis showedprogression of the retroperitoneal plaque to involve the superior mesenteric artery.SMA stenting was done after which her symptoms iproved. ConclusionRetroperitoneal fibrosis is rare and involvement of the superior mesenteric artery is even rarer. In a patient with RPF and persistent abdominal symptoms, there should be a high index of suspicion of SMA involvement. SMA stenting is the preferred minimally invasive option in SMA involvement in RPF.