Chronic abdominal pain secondary to mesenteric panniculitis treated successfully with endoscopic ultrasonography-guided celiac plexus block: A case report

Abstract

Mesenteric panniculitis is a chronic illness that is characterized by fibrosing inflammation of the mesenteries that can lead to intractable abdominal pain. Pain control is a crucial component of the management plan. Most patients will improve with oral corticosteroids treatment, however, some patients will require a trial of other immunosuppressive agents, and a minority of patients will continue to have refractory disease. Endoscopic ultrasound guided celiac plexus block is used frequently to control abdominal pain in patients with pancreatic pathology. To our knowledge there are no case reports describing its use in mesenteric panniculitis patients with refractory abdominal pain.

Keywords: Abdominal pain; Celiac plexus; Endoscopic-ultrasound; Mesenteric panniculitis.

Figure 1

Computed tomography of the abdomen. Computed tomography scan of the abdomen showing mesenteric irregularity and thickness.

Figure 2

Mesenteric biopsy. Mesenteric biopsy showing fibrotic band of dense collagen infiltrated by mixed inflammatory cells (lymphocytes, plasma cells and neutrophils). There is fat necrosis, no vasculitis or malignancy seen. There is no cellular atypia or lipoblast identified in the biopsy.

Figure 3

Ultrasonographic image of celiac plexus. This image is showing the celiac artery and celiac plexus (arrow).