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Deng X, Tang X, Yao H, Wang Y. Severe Venous Calcifications in Phlebosclerotic Colitis and Significantly Decreased Expression in Betaine. Int J Surg Pathol 2024:10668969241246475. [PMID: 38646813 DOI: 10.1177/10668969241246475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Phlebosclerotic colitis (PC) is a rare type of chronic ischemic colitis. Its etiology is still unknown, and PC is also known as idiopathic mesenteric phlebosclerosis colitis. Currently, many studies have reported that long-term use of Chinese herbal medicine and drinking history are related to its pathogenesis. In the early stage of the lesion, due to insufficient understanding of PC, it is difficult to distinguish it from inflammatory bowel disease and other nonneoplastic intestinal diseases. We reported a case of severe diffuse total colon calcification with multiple misdiagnosis, summarizing and analyzing the clinical pathological characteristics to increase clinical and pathological physicians' understanding of the disease and reduce misdiagnosis. Moreover, for the first time, we conducted metabolomics sequencing on fresh intestinal specimens of PC, in order to explore the possible mechanism of severe calcification in the patient. We found that betaine was significantly decreased in the intestinal specimens of the patient, which is an amino acid that has been shown to improve vascular risk factors, and may be one of the mechanisms underlying severe calcification in the patient.
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Affiliation(s)
- Xue Deng
- Chongqing Medical University, Chongqing, China
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
| | - Xuefeng Tang
- Chongqing Medical University, Chongqing, China
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
| | - Hui Yao
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
| | - Ying Wang
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
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Wang H, Zhao Z, Cao Q, Ning J. A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China. BMC Gastroenterol 2024; 24:48. [PMID: 38267839 PMCID: PMC10809466 DOI: 10.1186/s12876-024-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Mesenteric panniculitis (MP) represents the uncommon, benign and chronic inflammatory disorder affecting the mesenteric adipose tissues. Its etiology, diagnosis and treatment remain unnoticed. Our report focused on shedding more lights on this condition. PATIENTS AND METHODS Seventeen MP patients were identified by searching the electronic medical record system in the Zhengzhou Ninth People's Hospital using the search terms "Mesenteric panniculitis" from October 2015 to March 2023. All cases were diagnosed with MP through computed tomography (CT). Their clinical features and treatments were analyzed. RESULTS There were altogether 17 cases enrolled for this analysis. The male to female ratio was 8:9, and the median age at diagnosis was 64 (range: 37-96) years. There were 15 patients (88.2%) showing abdominal pain to varying degrees. The proportions of symptoms of nausea, vomiting and fever were 23.5%, 23.5% and 41.2%, respectively. Neoplastic disease was present in 3 patients (17.6%). Meanwhile, 9 patients (52.9%) had gallstones, 3 (17.6%) had cholecystitis and 1 (5.9%) had gallbladder polyps. Six patients (35.3%) received antibiotics treatment only and 1 (5.9%) received oral antibiotics and prednisone. One patient (5.9%) received antibiotics followed by prednisone treatment, because the symptoms were significantly relieved after antibiotic treatment, while the disease recurred soon after, and the symptoms improved again after prednisone treatment. The abdominal pain in 9 patients (52.9%) was relieved spontaneously. Two patients (11.8%) died, including one due to respiratory failure caused by pneumonia and the other one because of pancreatic cancer with lung and liver metastases. CONCLUSION MP is a poorly understood chronic inflammatory disease. Patients often have abdominal pain as the main symptom, accompanied by comorbidities in the gallbladder, and the prognosis is usually good after correct diagnosis and treatment, Therefore, the present report aims to promote the awareness among clinicians of patients with non-classic abdominal symptoms, so as to avoid misdiagnosis or missed diagnosis.
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Affiliation(s)
- Hongyan Wang
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Zhenyu Zhao
- Radiology, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Qiucai Cao
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Jing Ning
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China.
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Cecilio Azar, Ibrahim MA, El Kouzi Z, El Mokahal A, Omran N, Muallem N, Sharara AI. Mesenteric Panniculitis. Inflamm Intest Dis 2024; 9:157-164. [PMID: 39015257 PMCID: PMC11250460 DOI: 10.1159/000539432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/16/2024] [Indexed: 07/18/2024] Open
Abstract
Background Mesenteric panniculitis (MP) is an uncommon non-neoplastic idiopathic inflammation of adipose tissue, mainly affecting the mesentery of the small intestine, with its etiology remaining largely speculative. The difference in prevalence of MP among females and males varies across multiple studies. In most cases, MP is asymptomatic; however, patients can present with nonspecific abdominal symptoms or can mimic underlying gastrointestinal and abdominal diseases. The diagnosis is suggested by computed tomography and is usually confirmed by surgical biopsies if necessary. Treatment is generally supportive and based on a few selected drugs, namely, nonsteroidal anti-inflammatory drugs or corticosteroids. Surgery is reserved when the diagnosis is unclear, when malignancy is suspected or in the case of severe presentation such as mass effect, bowel obstruction, or ischemic changes. Summary MP is a rare inflammatory condition of the mesentery often asymptomatic but can cause nonspecific abdominal symptoms. Diagnosis relies on computed tomography imaging, with treatment mainly supportive, utilizing medications like nonsteroidal anti-inflammatory drugs or corticosteroids, while surgery is reserved for severe cases or diagnostic uncertainty. Key Messages MP causes abdominal pain, and it is mainly diagnosed with CT scan.
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Affiliation(s)
- Cecilio Azar
- Division of Gastroenterology, Clemenceau Medical Center, Dubai, United Arab Emirates
| | - Mohamad Ali Ibrahim
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zakaria El Kouzi
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali El Mokahal
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Omran
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim Muallem
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I. Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
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Zarog MA, O'Leary DP, Kiernan MG, Bolger J, Tibbitts P, Coffey SN, Lowery A, Byrnes GJ, Peirce C, Dunne CP, Coffey JC. Role of circulating fibrocytes in the diagnosis of acute appendicitis. BJS Open 2020; 4:1256-1265. [PMID: 33047514 PMCID: PMC7709380 DOI: 10.1002/bjs5.50350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Improved diagnostic biomarkers are required for acute appendicitis. The circulating fibrocyte percentage (CFP) is increased in inflammatory states, but has not been studied in acute appendicitis. This study aimed to determine CFP in acute appendicitis and compare diagnostic accuracy with standard serological biomarkers. Methods A prospective cohort study was carried out between June 2015 and February 2016 at University Hospital Limerick. The CFP was determined by dual‐staining peripheral venous samples for CD45 and collagen I using fluorescence‐activated cell sorting, and correlated with histopathological diagnoses. The accuracy of CFP in determining histological acute appendicitis was characterized and compared with the white cell count, C‐reactive protein concentration, neutrophil count, lymphocyte count and neutrophil : lymphocyte ratio. Results Of 95 adults recruited, 15 were healthy individuals and 80 had suspected appendicitis at presentation. Forty‐six of these 80 patients had an appendicectomy, of whom 34 had histologically confirmed appendicitis. The CFP was statistically higher in patients with pathologically proven acute appendicitis than in healthy controls (median 6·1 (i.q.r. 1·6–11·6) versus 2·3 (0·9–3·4) per cent respectively; P = 0·008). The diagnostic accuracy of CFP, as determined using the area under the receiver operating characteristic (ROC) curve, was similar to that of standard biomarkers. In multinomial regression analysis, only raised CFP was retained as an independent prognostic determinant of acute appendicitis (odds ratio 1·57, 95 per cent c.i. 1·05 to 2·33; P = 0·027). Conclusion The CFP is increased in histologically confirmed acute appendicitis and is as accurate as standard serological biomarkers in terms of diagnosis.
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Affiliation(s)
- M A Zarog
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - D P O'Leary
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - M G Kiernan
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - J Bolger
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - P Tibbitts
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - S N Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - A Lowery
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - G J Byrnes
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - C Peirce
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - C P Dunne
- Graduate Entry Medical School, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick, Ireland
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Özer Gökaslan Ç, Aslan E, Demirel E, Yücel A. Relationship of mesenteric panniculitis with visceral and subcutaneous adipose tissue. Turk J Med Sci 2020; 50:44-48. [PMID: 31655530 PMCID: PMC7080351 DOI: 10.3906/sag-1908-138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background/aim Mesenteric panniculitis (MP) is an idiopathic benign disease characterized by fat necrosis, chronic inflammation, and fibrosis. The relationship between obesity and chronic low-grade inflammation has been reported. This study investigated the relationship of MP diagnosed using multidetector computed tomography (MDCT) with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. Materials and methods We retrospectively enrolled 104 patients with no radiological findings other than MP. Additionally, 76 individuals without any indicative radiological findings were included as controls. VAT and SAT were separately calculated (cm2) using a 3-dimensional workstation. The abdominal circumference was measured (cm). Results The mean abdominal circumference was 99.9 ± 7.9 cm, SAT was 195.3 ± 89.1 cm2, and VAT was 203.9 ± 72.8 cm2 in the MP group. The abdominal circumference, VAT, and SAT were significantly higher in the MP group than in the control group (P < 0.001). According to the receiver operating characteristic (ROC) analysis, cut-off level VAT and SAT were 167.5 cm2 (sensitivity 71%, specificity 69%) and 117.5 cm2 (sensitivity 78%, specificity 51 %), respectively. Conclusion Increased VAT and SAT were associated with MP, suggesting their role in the etiology of MP.
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Affiliation(s)
- Çiğdem Özer Gökaslan
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyon, Turkey
| | - Eranil Aslan
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyon, Turkey
| | - Emin Demirel
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyon, Turkey
| | - Aylin Yücel
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyon, Turkey
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Buragina G, Magenta Biasina A, Carrafiello G. Clinical and radiological features of mesenteric panniculitis: a critical overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:411-422. [PMID: 31910164 PMCID: PMC7233778 DOI: 10.23750/abm.v90i4.7696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
The mesenteric panniculitis is a rare form of inflammation that mainly involves the mesenteric adipose tissue. The etiology remains unknown and the disease has been associated with various conditions such as cancer, abdominal trauma, previous surgery, autoimmune diseases and obesity. Mesenteric panniculitis can be divided into two main groups: the mesenteric panniculitis with only the inflammation and degeneration of the mesenteric fat, and the retractile panniculitis, mainly fibrotic, with retraction of the surrounding structures. From a radiological point of view, there are two main signs: the fat ring sign, which is the presence of normal fat around vessels and lymph nodes, and the pseudocapsula around the lesion. In this paper, we present the imaging and clinical features of mesenteric panniculits with particular reference to the differential diagnosis and the possible etiological associations. (www.actabiomedica.it)
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Kaya C, Bozkurt E, Yazıcı P, İdiz UO, Tanal M, Mihmanlı M. Approach to the diagnosis and treatment of mesenteric panniculitis from the surgical point of view. Turk J Surg 2018; 34:121-124. [PMID: 30023976 DOI: 10.5152/turkjsurg.2018.3881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/05/2017] [Indexed: 11/22/2022]
Abstract
Objective To evaluate the diagnostic and treatment approaches for patients diagnosed with mesenteric panniculitis. Material and Methods We retrospectively reviewed all patients diagnosed with mesenteric panniculitis between January 2010 and March 2016. We recorded the demographic features, clinical symptoms, laboratory values, radiological methods, treatment approach, and outcomes of the patients. Results We evaluated 22 patients (17 male and five female) with a mean age of 45.8±15.7 years. The most frequent complaint was abdominal pain. The patients' histories included colon cancer (n=1), prostatic cancer (n=2), renal cell cancer (n=1), diabetes mellitus (n=4), and chronic obstructive pulmonary disease (n=1). Laboratory values revealed elevated C-reactive protein levels in 14 patients (43%). Computed tomography was performed in all the patients. Only 10 patients were followed up in the surgical ward, the remaining 12 underwent outpatient treatment. No complication associated with hospitalization or during outpatient follow-up period was observed. Conclusion Mesenteric panniculitis can be successfully treated conservatively without surgical intervention. Clinical doubt is of great importance for diagnosis, and plausible underlying malignancy should be kept in mind.
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Affiliation(s)
- Cemal Kaya
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Emre Bozkurt
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yazıcı
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ufuk Oğuz İdiz
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mert Tanal
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Mihmanlı
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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8
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Klasen J, Güller U, Muff B, Candinas D, Seiler CA, Fahrner R. Treatment options for spontaneous and postoperative sclerosing mesenteritis. World J Gastrointest Surg 2016; 8:761-765. [PMID: 27933138 PMCID: PMC5124705 DOI: 10.4240/wjgs.v8.i11.761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/19/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
Sclerosing mesenteritis is a rare pathology with only a few described cases in the literature. The etiology is unclear; however, several potential triggers, including abdominal surgery and abdominal trauma, have been discussed. The pathology includes a benign acute or chronic inflammatory process affecting the adipose tissue of the mesenterium. Despite it being a rare disease, sclerosing mesenteritis is an important differential diagnosis in patients after abdominal surgery or patients presenting spontaneously with signs of acute inflammation and abdominal pain. We present here three cases with sclerosing mesenteritis. In two cases, sclerosing mesenteritis occurred postoperatively after abdominal surgery. One patient was treated because of abdominal pain and specific radiological signs revealing spontaneous manifestation of sclerosing mesenteritis. So far there are no distinct treatment algorithms, so the patients were treated differently, including steroids, antibiotics and watchful waiting. In addition, we reviewed the current literature on treatment options for this rare disease.
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Mohamed H, Mehdi C, Ikram M, Myriam M, Habib B, Adnene C. [Mesenteric panniculitis associated with acute pancreatitis: about a case]. Pan Afr Med J 2016; 24:206. [PMID: 27795801 PMCID: PMC5072865 DOI: 10.11604/pamj.2016.24.206.9322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/08/2016] [Indexed: 11/11/2022] Open
Abstract
Mesenteric panniculitis is a nonspecific inflammation involving the mesentery. Its clinical presentation is variable depending on the stage of the disease. Clinical signs are usually pain but half of the patients remain asymptomatic. Palpable abdominal mass, weight loss, nausea and vomiting. There may be an inflammatory syndrome of variable intensity. Panniculitis is suspected based on scan showing hyperdense mesentery with adhesions to adjacent organs. Histologically there is adipocyte degeneration causing foreign body reaction and appear lymphoplasmacytic inflammatory lesions. We report a new case of mesenteric panniculitis associated with acute pancreatitis.
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Affiliation(s)
- Hedfi Mohamed
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Charfi Mehdi
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Messaoudi Ikram
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Moussa Myriam
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Bouhawala Habib
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
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Abstract
In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as 'retractile mesenteritis.' It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.
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11
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Carbonell S, Melgar P, Payá A, Vilas I, Jover R, Romero M, Lluís F. [Mesenteric panniculitis of the colon]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:247-51. [PMID: 24508267 DOI: 10.1016/j.gastrohep.2013.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Silvia Carbonell
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España
| | - Paola Melgar
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España.
| | - Artemio Payá
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España
| | - Isolina Vilas
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España
| | - Rodrigo Jover
- Servicio de Digestivo, Hospital General Universitario de Alicante, Alicante, España
| | - Manuel Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España
| | - Félix Lluís
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España
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Rumman N, Rumman G, Sharabati B, Zagha R, Disi N. Mesenteric panniculitis in a child misdiagnosed as appendicular mass: a case report and review of literature. SPRINGERPLUS 2014; 3:73. [PMID: 25191632 PMCID: PMC4153878 DOI: 10.1186/2193-1801-3-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/31/2014] [Indexed: 12/21/2022]
Abstract
Mesenteric panniculitis is a chronic inflammatory process involving the adipose tissue of the mesentery. The etiology is unknown, and it is rare in children. We report a 5 year old girl who presented with abdominal symptoms and was misdiagnosed as appendicular mass. The correct diagnosis was established after surgical resection.
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Affiliation(s)
- Nisreen Rumman
- Department of Pediatrics, Makassed Hospital, Jerusalem, Palestine
| | - George Rumman
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
| | | | - Rami Zagha
- Department of Pathology, Al-Najah National University, Nablus, Palestine
| | - Nimer Disi
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
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Daumas A, Agostini S, Villeret J, Ah-Soune P, Emungania O, Granel B. Spontaneous resolution of severe, symptomatic mesocolic panniculitis: a case report. BMC Gastroenterol 2012; 12:59. [PMID: 22672224 PMCID: PMC3449199 DOI: 10.1186/1471-230x-12-59] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 06/06/2012] [Indexed: 02/08/2023] Open
Abstract
Background Mesenteric 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 presentation A 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. Conclusion Although 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.
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Affiliation(s)
- Aurélie Daumas
- Service de Médecine Interne, Assistance Publique-Hôpitaux de Marseille-AP-HM, Université AIX-MARSEILLE, Hôpital Nord, Chemin des Bourrely, 13915 Marseille Cedex 15, France.
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Nicholson JA, Smith D, Diab M, Scott MH. Mesenteric panniculitis in Merseyside: a case series and a review of the literature. Ann R Coll Surg Engl 2010; 92:W31-4. [PMID: 20615306 DOI: 10.1308/147870810x12699662981393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mesenteric panniculitis (also known as mesenteric manifestation of Weber-Christian disease, isolated lipodystrophy and mesenteric lipogranuloma), a benign inflammatory or fibrotic change in the mesentery of the bowel, is a rare diagnosis, particularly in the UK. Some 213 cases have been reported in the world-wide literature, just six from the UK. We present four cases of mesenteric panniculitis in Merseyside and review the literature surrounding this poorly understood phenomenon. Four patients who attended surgical out-patients with vague abdominal symptoms, and in two cases a palpable mass, were sent for abdominal computed tomography (CT) scan. One patient was admitted as an emergency with abdominal pain. In each patient there were clear signs of mesenteric panniculitis, first described in 1924. The 'classical' signs of mesenteric panniculitis seen on CT have been argued by some to be pathognemonic of the disease. In two cases, the patients underwent laparoscopic biopsies to confirm the diagnosis. We discuss the literature relating to mesenteric panniculitis, theories about its aetiology, confirmation of the diagnosis and consider the possibility that it is not actually as rare as we think. We suggest that it is rather under diagnosed due to the relative ignorance of the condition amongst both surgeons and radiologists the UK compared to the US, where mesenteric panniculitis is far more widely reported.
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Affiliation(s)
- J A Nicholson
- Department of Surgery, Whiston Hospital, Whiston, UK.
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Shin NY, Kim MJ, Chung JJ, Chung YE, Choi JY, Park YN. The differential imaging features of fat-containing tumors in the peritoneal cavity and retroperitoneum: the radiologic-pathologic correlation. Korean J Radiol 2010; 11:333-45. [PMID: 20461188 PMCID: PMC2864861 DOI: 10.3348/kjr.2010.11.3.333] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 02/01/2010] [Indexed: 12/17/2022] Open
Abstract
There are a variety of fat-containing lesions that can arise in the intraperitoneal cavity and retroperitoneal space. Some of these fat-containing lesions, such as liposarcoma and retroperitoneal teratoma, have to be resected, although resection can be deferred for others, such as adrenal adenoma, myelolipoma, angiomyolipoma, ovarian teratoma, and lipoma, until the lesions become large or symptomatic. The third group tumors (i.e., mesenteric panniculitis and pseudolipoma of Glisson's capsule) require medical treatment or no treatment at all. Identifying factors such as whether the fat is macroscopic or microscopic within the lesion, the origin of the lesions, and the presence of combined calcification is important for narrowing the differential diagnosis. The development and wide-spread use of modern imaging modalities make identification of these factors easier so narrowing the differential diagnosis is possible. At the same time, lesions that do not require immediate treatment are being incidentally found at an increasing rate with these same imaging techniques. Thus, the questions about the treatment methods have become increasingly important. Classifying lesions in terms of the necessity of performing surgical treatment can provide important information to clinicians, and this is the one of a radiologist's key responsibilities.
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Affiliation(s)
- Na-young Shin
- Department of Radiology, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
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Kornprat P, Liegl-Atzwanger B, Portugaller H, Bernhardt GA, Mischinger HJ. Sclerosing mesenteritis, a rare cause of a retroperitoneal tumor. Wien Klin Wochenschr 2010; 122:179-83. [DOI: 10.1007/s00508-010-1351-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
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Hiridis S, Hadgigeorgiou R, Karakitsos D, Karabinis A. Sclerosing mesenteritis affecting the small and the large intestine in a male patient with non-Hodgkin lymphoma: a case presentation and review of the literature. J Med Case Rep 2008; 2:388. [PMID: 19091063 PMCID: PMC2615039 DOI: 10.1186/1752-1947-2-388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 12/17/2008] [Indexed: 11/29/2022] Open
Abstract
Introduction Sclerosing mesenteritis is a rare disease resembling a mesenteric tumour. We present here a case of sclerosing mesenteritis that affected both the large and the small intestine of the patient. Therapeutic and diagnostic issues are discussed. Case presentation A 62-year-old man with a history of non-Hodgkin lymphoma presented with fatigue, a palpable tender abdominal mass and clinical signs of progressing intestinal obstruction. The preoperative evaluation failed to prove recurrence of the lymphoma or any other definite diagnosis. A laparotomy was performed through a midline incision. The mesentery resembled a tumour-like thickened and fibrotic mass. Abundant, rigid intestinal loop adhesions were observed. Diffuse fibrotic infiltration of the ileum and of the sigmoid colon, which obviously affected the intestinal vascular supply, were identified. A right colectomy and partial sigmoidectomy were performed. Pathological evaluation revealed extensive myofibroblastic reaction of the mesentery with accompanying loci of fat necrosis and areas of inflammation. A diffuse fibrotic infiltration that focally showed a ground-glass appearance was observed. The post-operative course was complicated by respiratory insufficiency and infections and the patient died 2 months after the operation. Conclusion Sclerosing mesenteritis that affects both the small and the large intestine is extremely rare. The disease is characterized by myofibroblastic reaction, fat necrosis and diffuse fibrosis of the mesentery. Pathological confirmation may be required for definite diagnosis. If the disease is characterized by severe and diffuse fibrosis, then the application of surgical therapy may be problematic.
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Affiliation(s)
- Savvas Hiridis
- Intensive Care Unit, General Hospital of Athens, Athens, Greece.
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Zafar AM, Rauf MA, Chawla T, Khanda G. Mesenteric panniculitis with pedal edema in a 33-year-old Pakistani man: a case report and literature review. J Med Case Rep 2008; 2:365. [PMID: 19055801 PMCID: PMC2612686 DOI: 10.1186/1752-1947-2-365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 12/04/2008] [Indexed: 11/24/2022] Open
Abstract
Introduction Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death. Case presentation A 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The patient underwent an exploratory laparotomy based on the finding of mesenteric soft-tissue density on computed tomography. The laparotomy did not prove to be of any diagnostic or therapeutic value. Upon review of the pre-operative computed tomographic scan at our institution, a diagnosis of mesenteric panniculitis was made. An acceptable resolution of abdominal pain and pedal edema was attained after a 4-week trial of immunosuppressive therapy. This is the first reported case of mesenteric panniculitis with pedal edema as part of its presentation. Conclusion An increased awareness may lead to the development of a less invasive diagnostic approach and optimal treatment for this rarely recognized condition.
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Affiliation(s)
- Abdul M Zafar
- Department of Radiology, Aga Khan University, Karachi, Pakistan.
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