An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis

Abstract

Objective: The aim of this study was to determine the prevalence of mesenteric panniculitis (MP) and to describe its clinical characteristics, therapy, and outcome. Subjects and Methods: This retrospective study was carried out among patients with MP based on computed tomography (CT) scans from January 2012 to December 2015. The CT images were reanalyzed by study radiologists to confirm the previous MP diagnosis. Patients were divided into 2 groups, i.e., idiopathicandsecondary, based on the presence or absence of associated predisposing factors such as trauma, malignancy, autoimmune disorders, ischemia, or previous abdominal surgery. The clinical characteristics of the 2 groups, as well as treatments, were assessed. Results: Among the 19,869 CT scans, 36 patients (0.18%) with MP were identified (i.e., 19 [53%] females and 17 [47%] males). The median age was 54 years (range 26 - 76). Twenty-four patients (67%) were categorized into the idiopathic group. Malignancy was the predisposing factor in 8 (22%) of those patients. Furthermore, abdominal pain was the cardinal symptom observed in 22 patients (92%) in the idiopathic group. In the idiopathic group, 15 patients (63%) were treated with antibiotics and 16 (67%) were treated with nonsteroidal anti-inflammatory drugs (NSAID). One unresponsive patient was treated with colchicine. Symptomatic relief was achieved in all of the treated patients. Conclusion: In thisstudy, a symptomatic idiopathic subgroup of patients with MP did not have any associated disorder. The response to treatment with antibiotics and NSAID was effective in most of the patients. Based on these findings, anti-inflammatory treatments beyond NSAID and surgery should be reserved for patients who are unresponsive to antibiotics and NSAID.

Acute Recurrent Exacerbations of Mesenteric Panniculitis With Immunosuppressive Therapy: A Case Report and a Brief Review

“… 11 MP is a spectrum of disease encompassing nonspecific inflammation of the mesenteric fat, which may ultimately lead to fibrosis and retraction. 4 It can be classified into 2 pathological subgroups 4 , 5 :…”

“…It can be classified into 2 pathological subgroups based on histopathological findings: inflammatory lesion predominant MP and fibrotic lesion predominant sclerosing mesenteritis. 4,5 MP may occur independently or in conjunction with other disorders but exact etiology is still unknown. Proposed causes of MP include autoimmune disorders, infections, ischemia of the mesentery and trauma, and it may also be associated with prior abdominal surgery, malignancy, vasculitis, and other granulomatous disorders.…”

Mesenteric Panniculitis with Raised Alanine Transaminase Levels: A Rare Case Report from Pakistan

“…Various drugs have been used to treat MP, including corticosteroids, colchicine, cyclophosphamide, azathioprine, tamoxifen, emetine, and thalidomide, as well as hormonal therapies and radiotherapy, all with varying degrees of success [15]. In general, treatment is reserved for symptomatic cases, as most cases are known to resolve spontaneously.…”

“…This highlights how the natural history of MP across the rest of the world may be different from that in Western countries, presumably due to lower sanitary conditions, infections with several unidentified microorganisms, and genetic differences. Therefore, we see the need for epidemiological studies from Asian and African countries to be conducted, in order to obtain more accurate epidemiologic data on MP [15].…”

The Complex Relationship between Mesenteric Panniculitis and Malignancy — A Holistic Approach is Still Needed to Understand the Diagnostic Uncertainties

“…Malignancy was identified in 45 patients (38%) (34 males). The most common malignancies were colorectal (14), lymphoma (13), and urogenital tract (7). Malignancies were diagnosed after the detection of mesenteric panniculitis in 13 patients.…”