Spontaneous resolution of severe, symptomatic mesocolic panniculitis: a case report

Abstract

BackgroundMesenteric panniculitis is a rare chronic fibrosing inflammatory disease that typically affects the adipose tissue and mesentery of the small intestine but may also affect the mesosigmoid and the mesocolon. The pathology of this disease remains unclear despite association with some malignancies or inflammatory disorders. We report a case of mesocolic panniculitis and a literature review of its clinical presentation, imaging findings, associated conditions and treatment options.Case presentationA 64 year-old Caucasian man was admitted to the gastroenterology department for severe weakness, left lower quadrant abdominal pain, weight loss and diarrhoea. Physical examination revealed a palpable firm mass occupying the entire left part of the abdomen. Abdominal CT-scan showed fatty infiltration of the mesosigmoid and left mesocolic fat which was strongly suggestive of panniculitis. Laparoscopic surgery revealed an inflamed and edematous mesocolon and mesosigmoid; the sigmoid mucosa appeared petechial which was suggestive of venous ischemia. Histological examination of surgical biopsies revealed mesocolic panniculitis. Despite exhaustive investigation, no associated conditions were found and the cause was classified as idiopathic. Surprisingly, the patient clinically improved without therapeutic intervention other than supportive care.ConclusionAlthough mesenteric panniculitis is most often a radiographic diagnosis without clinical symptomatology, it can also present with significant general status alteration. We report a case of mesocolic panniculitis complicated by development of an inflammatory mass associated with ischemic colitis. Mesenteric panniculitis is a difficult diagnosis to make which typically requires histologic confirmation. The overall prognosis is good with supportive treatment.

Sclerosing mesenteritis: update on diagnostic and therapeutic approach

“…42 The surgical approach should be limited to biopsy of the mass. 43 Therefore, surgery should be attempted only in patients with severe complications, such as bowel obstruction or perforation and advanced inflammatory changes irreversible. 42 Thus, researches related surgical resection must be individualized according to patient's anatomic characteristics due to the possibility of complications arise, becoming the worst life quality.…”

“…In the early stages, when fat necrosis is the main feature, it tends to settle spontaneously without. 26,35 As the disease progresses and chronic inflammation with or without fibrosis predominates, various agents have been used alone or in combination. Treatment has been attempted with a variety of drugs including steroids, azathioprine, cyclophosphamide, colchicine, tamoxifen, or radiotherapy, with different degrees of success.…”

“…26,[27][28][29][30][31] Some investigators report spontaneous resolution of disease, and others describe the curative resection and laparotomy is clearly indicated in the case of sclerosing mesenteritis, associated bowel obstruction nonresolving. 12,[29][30][31][32][33] In the absence of spontaneous resolution, several different therapeutic approaches have found some measure of success; although in the therapies are uniformly efficacious.…”

Sclerosing Mesenteritis-Update on Diagnostic and Therapeutic Approach

“…For example, if a long segment of the jejunum would have needed to be removed in the patient with small bowel mesentery of the jejunum which was shown to be widely involved on the CT scan and gross findings during laparotomy, such an operation could, with high probability, result in short bowel syndrome [44]. Although there is uncertainty about the optimal treatment, it is a situation with a favorable prognosis in most patients with good responses to treatment [6].…”

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

“…Mesenteric Panniculitis is a benign fibro-inflammatory process involving adipose tissue of the mesentery [1]. It is characterised by fat necrosis, chronic inflammation and fibrosis, causing thickening and shortening of the mesentery [2].…”