CT Evaluation of Mesenteric Panniculitis

Daskalogiannaki, M.; Voloudaki, Argyro; Prassopoulos, Panos; Magkanas, E.; Stefanaki, Kalliopi; Apostolaki, Eleni; Gourtsoyiannis, Nicholas

doi:10.2214/ajr.174.2.1740427

Cited by 254 publications

(179 citation statements)

References 21 publications

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“…Two showed a clinical improvement, and one had on-going intermittent abdominal pain. On follow-up CT, none of the patients had resolution or change in the mass [3]. The evidence for radiological improvement from other case reports following treatment is mixed [9,13,15].…”

Section: Discussionmentioning

confidence: 60%

“…Of these, 49 demonstrated mesenteric panniculitis. 34 cases were associated with malignant disease, 11 cases associated with benign disease, and in the remaining 4 cases no association was identified [3].…”

Section: Discussionmentioning

confidence: 97%

“…Documented presenting symptoms include abdominal pain, palpable mass, weight loss, small bowel obstruction, diarrhoea and chylous ascites [7,8]. Occasionally it is asymptomatic, identified as an incidental finding on CT [3].…”

Section: Discussionmentioning

confidence: 99%

“…Etiological associations of mesenteric panniculitis include malignancy, infectious disease, autoimmune disease, vasculitis, cirrhosis, peptic ulcer disease, pancreatitis, abdominal aortic aneurysm, previous abdominal surgery and elevated IgG4 related disease [3] (a fibroinflammatory condition initially associated with autoimmune pancreatitis, but now recognised in a number of conditions including atopic dermatitis, vasculitis, pancreatic cancer, biliary tract disease, and also present in 5% of the normal population) [10].…”

Section: Discussionmentioning

confidence: 99%

“…It is characterised by fat necrosis, chronic inflammation and fibrosis, causing thickening and shortening of the mesentery [2]. The pathophysiology remains unclear, although it has been linked with malignancy-in particular lymphoma, gastrointestinal and genitourinary [3]. Patients with mesenteric panniculitis may present with localised abdominal pain, abdominal mass, intestinal obstruction and ischaemic colitis, however between 30% -50% remain asymptomatic [2].…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Mesenteric Panniculitis and Primary Sjögren’s Syndrome

Batten

Ng²

2013

OJRA

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Mesenteric Panniculitis is a benign fibro-inflammatory process involving adipose tissue of the mesentery. It is characterised by fat necrosis, chronic inflammation and fibrosis, causing thickening and shortening of the mesentery. Patients may present with localised abdominal pain, abdominal mass, intestinal obstruction and ischaemic colitis. We report a case of mesenteric panniculitis causing abdominal pain in a patient with active Primary Sjögren's Syndrome. The rarity of this case makes it of interest. We review the current literature on mesenteric panniculitis and its association with connective tissue disease and inflammatory conditions. A 64-year-old Caucasian male presented in 1994 with dry mouth. A diagnosis of Primary Sjögren's Syndrome (PSS) was made on salivary gland biopsy. In 2010 he presented with an exacerbation of his eye symptoms, muscle pain and fatigue. He complained of abdominal pain and night sweating, but denied any weight loss or change in bowel habit. There was no significant past medical history other than PSS. On examination he had a small right submandibular node and mild synovitis at the right proximal interphalangeal joint and carpometacarpal joint. Examination of the abdomen showed marked umbilical tenderness but no organomegally. Blood tests at this time showed an active inflammation: CRP of 61 (NR < 5 mg/L), ESR 39 (NR < 20 mm/s), strongly positive ENA Ro and La. IgG was elevated at 18.6 (NR 5.8 -15.4), Complement was low at 0.17 (NR 0.18 -0.6). An abdominal ultrasound scan demonstrated a 6 × 3 × 3 cm area of diffuse homogenous fat encasing some mesenteric vessels in the area of focal tenderness. CT abdomen and pelvis showed oedematous mesenteric fat and lymph nodes in the jejunal small bowel mesentery, consistent with mesenteric panniculitis. Laparoscopic biopsy was discussed with the surgical team, but was felt not indicated as risk outweighed potential benefit. The patient was treated with a 9-week reducing course of oral steroids. His abdominal symptoms resolved although CT abdomen showed little improvement in mesenteric panniculitis. A review of the literature suggests that currently there is no standard treatment and management should be guided by patient symptoms. Mesenteric Panniculitis is rare; as a result evidence for treatment is limited to individual case reports. There is no clear link between symptom improvement and radiological resolution of mesenteric panniculitis. It has, therefore been suggested that follow-up imaging should be limited to those with persistent symptoms. Overall the prognosis for mesenteric panniculitis is good, up to half of patients do not require treatment, and recurrence of symptoms is uncommon.

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