Mesenteric Panniculitis

What is Mesenteric Panniculitis?

Mesenteric panniculitis can be described as a rare condition, in which the adipose tissue of the bowel mesentery suffers from a chronic, non-specific inflammatory process. It is important to understand that this fibrosing inflammatory disease is benign. The condition was described for the first time in 1924, being presented as retractile mesenteritis. It was re-named mesenteric panniculitis in the 1960s and, today, it is also known as mesenteric sclerosis, mesenteric Weber-Christian disease and liposclerotic mesenteritis.

There are three main changes that occur with this diagnosis, meaning fibrosis, necrosis of the adipose tissue and chronic, non-specific inflammation. This condition will retain the name of mesenteric panniculitis, in the situation that the inflammation and the necrosis of the fat predominate over the fibrosis. On the other hand, if the fibrosis and retraction are the ones predominating, it will be more commonly presented as retractile mesenteritis. The term “sclerosing mesenteritis” might also be used in the situation that there is some degree of fibrosis present.

This condition is more often encountered in men and especially in Caucasians. The incidence of the mesenteric panniculitis increases with age – it is extremely rare encountered in children, perhaps due to the reduced amount of mesenteric fat in comparison to adults.

Causes

The exact cause of the mesenteric panniculitis has yet to be identified. Among the potential reasons that have been incriminated in the appearance of this condition, there are: autoimmune response (caused by an unknown source), mesenteric ischemia. The condition is often found in association with different types of cancer, such as lymphoma but this is not considered a cause.

More than 80% of the patients have reported a history of trauma or surgery at the level of the abdomen. Other potential risk factors for the appearance of this condition include: thrombosis of the mesentery, taking certain medication, thermal/chemical burns, vitamin deficiencies, retained suture materials, pancreatitis, leakage of the bile, bacterial infections. The presence of gallstones, coronary disease and cirrhosis have also been found in association with the mesenteric panniculitis.

Symptoms

These are the symptoms that can appear in patients who suffer from mesenteric panniculitis:

• Pain in the right side of the abdomen (moderate intensity, can last for a long time)
• Nausea
• Vomiting
• Syncope (few seconds duration)

Diagnosis

The diagnosis of mesenteric panniculitis is often made with the help of imaging studies, such as the CT scan (often performed with IV contrast, as it allows for better visualization). However, the final confirmation of the diagnosis is confirmed through the surgical biopsy.

The physical examination of the patient does not reveal any specific changes for this condition. The patient might present moderate abdominal tenderness upon palpation, especially in the right quadrant. An ill-defined mass can also be felt through the palpation of the abdomen. The medical history of the patient will reveal the chronic abdominal discomfort, as well as other long-term symptoms.

Treatment

The treatment of the mesenteric panniculitis is empiric and it often consists of medication. Corticosteroids, such as prednisone, are often chosen as a line of treatment. This treatment guarantees a reduction in the intensity of pain experienced by the patient, as well as an improvement in the other symptoms. The mesenteric mass, if any, is also going to decrease upon receiving this treatment. Colchicine is administered as an alternative to corticosteroids, as it does not have so many side-effects. Among the most uncomfortable side-effects of the corticosteroids, there are: peripheral neuropathy and increased levels of glucose (hyperglycemia).

Depending on the seriousness of the cases, the surgical resection might be attempted as a form of definitive therapy. However, it must be mentioned that the surgical approach has a rather limited effect.