Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition

Abstract

Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis. There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions. While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.

Keywords: adipose tissue; autoimmune disease; computerized tomography; laparoscopy; lymphatics; lymphoma; mesenteric fibrosis; mesenteric lipodystrophy; mesenteric panniculitis; neoplasms; paraneoplastic conditions; positron emission tomography; retractile mesenteritis; sclerosing mesenteritis.

Fig. 1

Photograph of an axial image of the abdomen obtained on computerized axial tomographic assessment of a 35-year-old male patient with a history of previously treated lymphoma. The white arrows demonstrate a mesenteric panniculitis-like abnormality with hazy mesenteric fat and numerous discrete small, and chronically stable nodes.

Fig. 2

Photograph of an axial image of the abdomen obtained on computerized axial tomographic (CT) assessment of a 50-year-old male patient diagnosed with idiopathic mesenteric panniculitis. There is distinct haziness in the root of the mesentery (white arrows). Although this surrounds mesenteric vessels the latter are spared. There are no pathologic enlarged nodes. An underlying cause of the CT findings was not found.