A Clinical Review of Mesenteric Panniculitis

Abstract

Mesenteric panniculitis (MP) is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery. MP is commonly detected incidentally on cross-sectional imaging of the abdomen and can be asymptomatic in up to nearly half of patients. The most frequent clinical symptom reported is abdominal pain, followed by bloating/distention, diarrhea, constipation, vomiting, anorexia, weight loss, fever, malaise, and nausea. On computed tomography, MP is seen as a mass-like area of increased fat attenuation within the small bowel mesentery, usually located in the left upper quadrant of the abdomen. This mass-like area envelops mesenteric vessels and displaces adjacent bowel segments. Lymph nodes are frequently seen within the area of mesenteric abnormality. One of the most common differential diagnoses of MP is lymphoma, and positron emission tomography/computed tomography may be performed if there is suspicion of a concurrent underlying malignancy. Because of the benign nature of MP, treatment decisions should be guided by severity of symptoms and presence of complications. First-line medical treatment is prednisone and tamoxifen. Surgery is reserved for cases of recurrent bowel obstruction. This article provides a review of MP, including its epidemiology, pathophysiology, clinical presentation, imaging findings, and treatment.

Keywords: Mesenteric panniculitis; inflammation; mesentery; small bowel.

Figure 1.

Proposed diagnostic algorithm for mesenteric panniculitis. ^aThe majority of patients who are diagnosed with mesenteric panniculitis. CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; GI, gastrointestinal.

Figure 2.

Axial contrast-enhanced computed tomography image of a 70-year-old man with mesenteric panniculitis showing a mass-like area of increased fat attenuation (arrows) within the mesentery that displaces adjacent segments of bowel.

Figure 3.

Axial noncontrast computed tomography image of a 64-year-old man with mesenteric panniculitis showing a mass-like area of increased fat attenuation within the mesentery with a thin peripheral curvilinear band of soft tissue (arrows), referred to as a tumoral pseudocapsule sign.

Figure 4.

Axial contrast-enhanced computed tomography image of a 54-year-old woman with mesenteric panniculitis showing a mass-like area of increased fat attenuation within the mesentery with preservation of normal fat density surrounding mesenteric vessels (arrows), referred to as a fat halo sign.