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Ohno M, Nishida A, Imai T, Tanaka E, Takahashi K, Miyake T, Tani M, Kushima R, Inatomi O. Relapsing sclerosing mesenteritis with multiple strictures of the small intestine. Clin J Gastroenterol 2024; 17:839-843. [PMID: 38811510 DOI: 10.1007/s12328-024-01989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
Sclerosing mesenteritis (SM) is a rare disorder that involves the mesenteric adipose tissue with chronic fibrosing inflammation. Few reports mention the natural history of severe SM cases. Here, we report a severe and relapsing SM case in which a long-term natural history could be followed. The patient had undergone surgery for small bowel stenosis of unknown cause 10 years earlier. He had stopped visiting the hospital at his discretion. He was admitted to the hospital 10 years later due to recurrent symptoms, and a close examination revealed multiple small intestinal strictures; thus, surgery was performed again. The pathological results revealed that the patient had SM, corticosteroid administration dramatically improved his symptoms, and he has maintained remission for a long time.
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Affiliation(s)
- Masashi Ohno
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan.
- Department of Gastroenterology and Hepatology, Nagahama City Hospital, Nagahama, Shiga, 526-8580, Japan.
| | - Atsushi Nishida
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
- Department of Gastroenterology and Hepatology, Nagahama City Hospital, Nagahama, Shiga, 526-8580, Japan
| | - Takayuki Imai
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Eri Tanaka
- Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Kenichiro Takahashi
- Department of Gastroenterology and Hepatology, Nagahama City Hospital, Nagahama, Shiga, 526-8580, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
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2
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Ahmed M. A clinician's perspective on the new organ mesentery and non-vascular mesenteropathies. Front Physiol 2024; 15:1336908. [PMID: 39296517 PMCID: PMC11408482 DOI: 10.3389/fphys.2024.1336908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 07/17/2024] [Indexed: 09/21/2024] Open
Abstract
Mesentery was discovered as a new organ in 2017. It is a continuous membranous tissue from the duodenojejunal flexure to the anorectal junction. It has distinct anatomy, physiology, and disease states. Primary mesenteropathies include vascular and non-vascular diseases. Some of them are common, and some of them are rarely seen in clinical practice. Secondary mesenteropathies occur when infection or malignancy in another organ spreads to the mesentery. Each entity has specific diagnostic and treatment protocols. Increased awareness of different mesenteropathies and an understanding of their various presentations at different stages of life can help in early diagnosis and improved clinical outcomes.
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Flor N, Ferretti F, Pellegrinelli A, Tubazio I, Colombo F. Sclerosing mesenteritis: a rare disease involving the adipose tissue of the bowel mesentery. Intern Emerg Med 2024; 19:1493-1495. [PMID: 38194001 DOI: 10.1007/s11739-023-03510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Nicola Flor
- Unità Operativa Di Radiologia, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Francesca Ferretti
- Unità Operativa Di Gastroenterologia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Alessandro Pellegrinelli
- Unità Operativa Di Anatomia Patologica, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Igor Tubazio
- Unità Operativa Di Chirurgia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Francesco Colombo
- Unità Operativa Di Chirurgia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
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Wang J, Li B. CT findings of idiopathic mesenteric panniculitis and analysis of related factors. Eur J Radiol 2023; 167:111071. [PMID: 37666075 DOI: 10.1016/j.ejrad.2023.111071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To analyze the computed tomography (CT) findings of idiopathic mesenteric panniculitis and the factors related to its characteristics and to improve the understanding of the disease. METHODS The imaging findings of 121 patients with mesenteric panniculitis were retrospectively analyzed, along with related factors such as age, sex, and abdominal visceral fat area. RESULTS Among the 121 patients, two had midgut malrotation, and the lesions were located outside the mesentery on the right side of the abdominal cavity, while the lesions in the other patients were located around the mesentery on the left side of the abdominal cavity, presenting as patchy or patchy fuzzy high-density masses. Annulus fibrosus and/or fatty ring signs were also observed in some patients. Scattered soft tissue nodules were observed around the mesentery in 119 patients. Eight patients had intestinal tract traction and retraction, and one patient had secondary intestinal obstruction. Nearly half of the patients had mesenteric vascular changes, and three had mesenteric vascular thrombosis. Among the 121 patients, there were 89 males and 32 females, aged 22-83, with an average age of 52.14 ± 13.53 years. The distribution range of abdominal visceral fat area (VFA) in 121 patients was 79.85-331.65 cm2. CONCLUSION Mesenteric panniculitis has certain characteristic imaging findings that can be accompanied by often ignored changes in the mesenteric blood vessels and intestinal tubes. Intestinal obstruction and mesenteric vascular thrombosis are rare complications, and their primary causes are often overlooked. Mesenteric panniculitis was correlated with sex, age, and VFA.
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Affiliation(s)
- Jieqiong Wang
- Radiology Department, Taikang Xianlin Drum Tower Hospital, No. 188 Lingshan North Road, Qixia District, Nanjing City, Jiangsu Province, China
| | - Baohong Li
- Radiology Department, Taikang Xianlin Drum Tower Hospital, No. 188 Lingshan North Road, Qixia District, Nanjing City, Jiangsu Province, China.
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Chennavasin P, Gururatsakul M. Idiopathic sclerosing mesenteritis presenting with small bowel volvulus in a patient with antiphospholipid syndrome: A case report. World J Clin Cases 2023; 11:3304-3310. [PMID: 37274053 PMCID: PMC10237130 DOI: 10.12998/wjcc.v11.i14.3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Sclerosing mesenteritis is a rare disorder involving inflammation of the mesentery. Its etiology remains unclear, but it is believed to be associated with previous abdominal surgery, trauma, autoimmune disorders, infection, or malignancy. Clinical manifestations of sclerosing mesenteritis are varied and include chronic abdominal pain, bloating, diarrhea, weight loss, formation of an intra-abdominal mass, bowel obstruction, and chylous ascites. Here, we present a case of idiopathic sclerosing mesenteritis with small bowel volvulus in a patient with antiphospholipid syndrome.
CASE SUMMARY A 68-year-old female presented with recurrent small bowel obstruction. Imaging and pathological findings were consistent with sclerosing mesenteritis causing mesenteric and small bowel volvulus. Computed tomography scans also revealed pulmonary embolism, and the patient was started on a high dose of corticosteroid and a therapeutic dose of anticoagulants. The patient subsequently improved clinically and was discharged. The patient was also diagnosed with antiphospholipid syndrome after a hematological workup.
CONCLUSION Sclerosing mesenteritis is a rare condition, and patients with no clear etiology should be considered for treatment with immunosuppressive therapy.
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Affiliation(s)
- Papawee Chennavasin
- Department of Surgery, Chulabhorn Hospital, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Montri Gururatsakul
- Department of Gastroenterology and Hepatology, Chulabhorn Hospital, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
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Abstract
Mesenteric panniculitis is encountered frequently during abdominopelvic CT scanning, often as an incidental finding. The observation is problematic because an association with malignancy has been raised in the literature. This review will describe the CT appearances and examine the available evidence regarding the significance of this finding.Ultimately, the literature remains unclear regarding how these patients should be managed, if at all.
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Affiliation(s)
- Vivienne N Eze
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Steve Halligan
- University College London Centre for Medical Imaging, London, United Kingdom
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Gavriilidis P, de' Angelis N. Conservative Management of Mesenteric Panniculitis in a Remote Island. Case Rep Surg 2023; 2023:3335738. [PMID: 37124971 PMCID: PMC10147526 DOI: 10.1155/2023/3335738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Mesenteric panniculitis (MP) includes a spectrum of nonspecific fibroinflammatory disorders of unknown aetiology that affects mainly the root of the mesentery. Case Report. A 68-year-old man is incidentally diagnosed with MP during follow-up investigation for a fusiform coeliac artery aneurysm. Four years since the diagnosis, he is completely asymptomatic. After discussing with him and presenting the current evidence, he decided not to proceed with biopsy because the finding was incidental and he is asymptomatic. Moreover, tumour markers were within the normal range. He has been scheduled for annual follow-ups with computerized tomography (CT) scans and tumour markers. Conclusions MP is a rare chronic fibroinflammatory disease with contradictory evidence regarding its definition and management. Watchful follow-ups with CT scan and tumour markers are recommended for asymptomatic patients.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgery, Saint Helena General Hospital, Jamestown, STHL 1ZZ, Saint Helena, UK
| | - Nicola de' Angelis
- Colorectal and Digestive Surgery Unit at Hospital Beaujon, 100 Bd du Général Leclerc, Clichy 92110, France
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Whittle C, Schiappacasse G, Maldonado I, Villacres F, Hebel E, González F. Recognizing the Ultrasound Patterns of Mesenteric Panniculitis. Ultrasound Q 2022; 38:185-190. [PMID: 33394995 DOI: 10.1097/ruq.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Mesenteric panniculitis (MP) is a rare, benign, and nonspecific chronic fibrosing inflammation of the mesenteric adipose tissue. Abdominal pain is the most frequent presentation.The objective was to recognize ultrasound (US) features in MP. A retrospective 9-year review of computed tomography- (CT) or US-diagnosed cases of MP recorded in the radiology department was performed. The inclusion criteria included an US recorded in PACS imaging data base within 10 days before CT, to compare and evaluate the correlation of MP diagnosis.The prevalence of MP on CT was 2.8%. The 120 selected patients had an abdominal US 10 days before CT. Male-to-female ratio was 4:1. Fifty-three percent of MP was suggested by US. The US finding was increased volume with fatty mass in the mesentery root (98%). The fatty mesenteric mass had oval shape or convex anterior border in 94%, central abdominal location in 91%, and focal mesenteric increased echogenicity in 95%. Lateral bowel loop displacement was observed in 59%. Detection of lymph nodes was less frequent (55%).In conclusion, MP is an entity to be considered in the differential diagnosis of abdominal pain. Knowledge and recognition of the US findings of MP and central abdominal compression may improve detection during the abdominal US examination.
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Affiliation(s)
| | | | | | - Fabian Villacres
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Esteban Hebel
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Santiago, Chile
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9
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Alyousef IA, Alsaileek ZA, Alabdulsalam MA, Almohanna MA, Alshaqhaa NA, Alqahtani MM, Al Alyany AA, Alzahrani MA, Fallatah HA, Alqadhib JI, Alhawsawi AM, Alsuhaymi AD, Alasmari AM, Alshareef AJ, Al-Hawaj F. Mesenteric Panniculitis and COVID-19: A Rare Association. Cureus 2022; 14:e21314. [PMID: 35186573 PMCID: PMC8849467 DOI: 10.7759/cureus.21314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/06/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) typically involves the respiratory system, but gastrointestinal involvement is common. Further, patients with severe COVID-19 are at high risk to develop gastrointestinal complications, including bowel ischemia, ileus, and deranged liver enzymes. We present the case of a 44-year-old woman with mild COVID-19 pneumonia who was in home isolation. Ten days after the isolation, the patient presented to the emergency department complaining of generalized abdominal pain that was sharp in nature and associated with nausea and recurrent episodes of vomiting. The patient did not complain of any respiratory symptoms. Physical examination showed diffuse tenderness with no clinical signs to suggest generalized peritonitis. The laboratory parameters showed normal hematological, renal, and hepatic profiles. No elevation in the inflammatory markers was observed. The amylase level was within the normal range. Abdominal computed tomography scan demonstrated the presence of misty mesentery with increased density of the mesentery with fat stranding encasing the mesenteric vessels along with mesenteric adenopathy. Such radiological features suggested the diagnosis of mesenteric panniculitis. Subsequently, intravenous corticosteroid therapy was initiated and the patient exhibited significant improvement after 24 hours. The patient was discharged after nine days of hospitalization. She was followed up after one month and she had no complaints. Mesenteric panniculitis is a rare idiopathic inflammatory condition involving the mesenteric adipose tissue. The case shed a light on the possible association of COVID-19 with mesenteric panniculitis. The clinical manifestations of mesenteric panniculitis are non-specific and imaging studies are essential to suggest the diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jalal I Alqadhib
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | | | | | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Brancato G, Donati M, Salvatorelli L, Magro G, Zanatta M, Lentini F, Basile G. Nodular Sclerosing Mesenteritis: An Occasional Finding Mimicking a Spindle Cell Tumor. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933189. [PMID: 34836933 PMCID: PMC8635222 DOI: 10.12659/ajcr.933189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 83-year-old
Final Diagnosis: Sclerosing mesenteritis
Symptoms: Abdominal pain • intestinal obstruction • vomiting
Medication: —
Clinical Procedure: —
Specialty: Surgery
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Affiliation(s)
- Giovanna Brancato
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Marcello Donati
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Lucia Salvatorelli
- Department of Medical-Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Pathology, University of Catania, Catania, Italy
| | - Gaetano Magro
- Department of Medical-Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Pathology, University of Catania, Catania, Italy
| | - Michela Zanatta
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Francesca Lentini
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Guido Basile
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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11
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Debilitating Manifestation of a Disease with Multiple Names: A Severe Case of Sclerosing Mesenteritis. Case Rep Gastrointest Med 2021; 2021:6629424. [PMID: 33628534 PMCID: PMC7884159 DOI: 10.1155/2021/6629424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare inflammatory condition with unknown etiology that affects the mesenteric adipose tissue. We present a case of a 49-year-old male with severe abdominal pain who underwent abdominal biopsy confirming the presence of adipose inflammation and necrosis. The diagnosis of SM was made, and the patient was treated with prednisone and tamoxifen. As this condition is rare, there are no standard guidelines for management. This case aims to outline a possible treatment plan.
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Abstract
Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.
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13
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Sharma P, Hegde R, Kulkarni A, Soin P, Kochar P, Rotem E. Imaging right lower quadrant pain: Not always appendicitis. Clin Imaging 2020; 63:65-82. [PMID: 32163846 DOI: 10.1016/j.clinimag.2020.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Although acute appendicitis (AA) is one of the commonest causes of right lower quadrant abdominal pain (RLQP), there are numerous other conditions in the abdomen and pelvis that can simulate the clinical presentation of AA for which imaging is essential in detection. We discuss the approach to evaluation of patients presenting with acute onset RLQP and the choice of various imaging modalities that can be utilized. Although CT remains the workhorse in evaluation, US and MRI, given lack of radiation, play an important ancillary role, particularly in the pediatric and pregnant patients. We present a spectrum of conditions presenting with RLQP which we have classified systematically ranging from conditions affecting the bowel, mesentery/omentum/peritoneum, vasculature, urinary and reproductive systems to give the reader a checklist of conditions to consider when evaluating a case of RLQP.
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Affiliation(s)
- Pranav Sharma
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
| | - Rahul Hegde
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America.
| | - Ashwini Kulkarni
- Department of Radiology, University of Massachusetts, Worcester, MA, United States of America
| | - Priti Soin
- Department of Pathology, Penn State College of Medicine, Hershey, PA, United States of America
| | - Puneet Kochar
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
| | - Eran Rotem
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
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14
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Dahiya DS, Kichloo A, Singh J, Albosta MS, Wani F, Aljadah M, Haq KF. Acute Recurrent Exacerbations of Mesenteric Panniculitis With Immunosuppressive Therapy: A Case Report and a Brief Review. J Investig Med High Impact Case Rep 2020; 8:2324709620969581. [PMID: 33138661 PMCID: PMC7649945 DOI: 10.1177/2324709620969581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mesenteric panniculitis (MP) is a rare, benign, and idiopathic disorder characterized by chronic inflammation of the mesenteric adipose tissue of the small intestine. The exact etiology of MP is unknown and its associations with underlying malignancies continues to be poorly understood. In this case report, we describe a rare case of acute exacerbations of MP in a middle-age female with a known past medical history of non-Hodgkin’s lymphoma in remission and small bowel resection for a localized carcinoid tumor. The patient was diagnosed with MP 4 years ago and started on tamoxifen therapy with adequate control of her symptoms. Last year, she reported to the emergency department with multiple episodes of sudden-onset, severe, and localized right upper quadrant abdominal pain and nausea without vomiting. She was diagnosed with an acute exacerbation of MP and a decision was made to add 60 mg prednisone daily in addition to her tamoxifen regimen. She remained symptomatically stable for the next 6 months after the start of dual therapy with tamoxifen and prednisone. However, for the past 6 months, the patient reported to the emergency department on an average of 2 times/month with the same recurrent symptoms despite high compliance with tamoxifen and prednisone therapy. She was admitted for her pain management and her dose of prednisone was increased and she was subsequently discharged home with improvement of her symptoms. Her tamoxifen was switched to mycophenolate on her follow-up visit with gastrointestinal clinic, and her disease has remained stable for the past 2 months. Our case report discusses in-depth the literature on MP and its management. We also detail the steps in management of a rare case of recurrent acute exacerbations of MP despite the patient being on immunosuppressive therapy.
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Affiliation(s)
| | | | | | | | - Farah Wani
- Central Michigan University, Saginaw, MI, USA
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15
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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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Meyyur Aravamudan V, Khan SR, Natarajan SK, Hussain I. The Complex Relationship between Mesenteric Panniculitis and Malignancy - A Holistic Approach is Still Needed to Understand the Diagnostic Uncertainties. Cureus 2019; 11:e5569. [PMID: 31695988 PMCID: PMC6820662 DOI: 10.7759/cureus.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Mesenteric panniculitis is an idiopathic, localized inflammation involving the adipose tissue of the small bowel mesentery. The association of mesenteric panniculitis with malignancy, predominantly lymphomas, has been widely reported in the medical literature. In this review article, we will discuss the clinical guidelines in the diagnosis and management of mesenteric panniculitis and the clinical association between mesenteric panniculitis and malignancies.
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Affiliation(s)
| | - Shahab R Khan
- Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, USA
| | | | - Ikram Hussain
- Internal Medicine: Gastroenterology, Woodlands Health Campus, Singapore, SGP
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Abstract
Sclerosing mesenteritis is a rare non-neoplastic disorder characterized by fat necrosis, chronic inflammation, and fibrosis typically of the small bowel mesentery. Our understanding of this disorder is limited by its rarity as well as inconsistent terminology used across the literature. While prior abdominal surgery or trauma, autoimmunity, infection, ischemia, and malignancy have been suggested to be involved in the pathogenesis of the disorder, it remains poorly understood. The clinical course of sclerosing mesenteritis is generally benign with a large proportion of patients diagnosed incidentally on imaging obtained for other indications. In a subset of patients, symptoms may arise from a mass effect on the bowel, lymphatics, or vasculature resulting in bowel obstruction, chylous ascites, or mesenteric ischemia. Symptomatic patients should be treated with a combination of corticosteroid and tamoxifen as first-line therapy based on retrospective case series and experience in other fibrosing disorders. Surgical intervention may be required in those with persistent obstruction despite conservative treatment, though complete resection of the mass is often not feasible given intimate involvement with the mesenteric vasculature. A careful use of terminology and communication between the radiologist, pathologist, and clinicians in the care of these patients will be essential to future efforts at understanding this disease.
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18
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Rizos EC, Panagiotopoulou T, Liberopoulos E, Elisaf M, Tsili A, Argyropoulou MI, Tigas SK. IS MESENTERIC PANNICULITIS A SIGN FOR AUTOIMMUNE DIABETES IN ADULTS? AACE Clin Case Rep 2019; 5:e181-e183. [PMID: 31967029 PMCID: PMC6876940 DOI: 10.4158/accr-2018-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/01/2018] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Mesenteric panniculitis (MP) and sclerosing mesenteritis is an umbrella term used to describe a rare, chronic, and frequently benign fibrosing inflammatory disease that affects the adipose tissue of the mesentery. The diagnosis is usually based on imaging (computed tomography [CT] or magnetic resonance imaging) findings and is confirmed by biopsy. We report the unusual case of a patient with MP with typical CT findings and diabetes mellitus (DM). METHODS A 48-year-old male presented for symptomatic new onset DM. An abdominal CT scan revealed a well-defined mesenteric mass compatible with MP. The combination of insulin degludec and sitagliptin/metformin resulted in a decrease of HbA1c; however, this was followed by a subsequent gradual increase in HbA1c and positive glutamic acid decarboxylase auto-antibodies. RESULTS The patient developed auto-immune DM that was confirmed by the presence of auto-antibodies. CONCLUSION Panniculitis has been infrequently reported in patients with type 2 DM. This is the first report of a patient with MP correlated with auto-immune DM. The possible pathophysiologic mechanisms are discussed.
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Ayaz E, Aktan A, Alimoğlu A, Ozdas I. UNUSUAL CAUSES OF THE ACUTE ABDOMINAL PAIN: IMAGING AND CLINICAL FINDINGS. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2019. [DOI: 10.33706/jemcr.551138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Al-Omari MH, Qararha K, Garaleh M, Smadi MM, Hani MB, Elheis M. Mesenteric panniculitis: comparison of computed tomography findings in patients with and without malignancy. Clin Exp Gastroenterol 2018; 12:1-8. [PMID: 30643446 PMCID: PMC6311320 DOI: 10.2147/ceg.s182513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose The aim was to compare computed tomography (CT) findings between patients with mesenteric panniculitis (MP) with and without known malignancy. Patients and methods We retrospectively analyzed 116 consecutive patients who were diagnosed with MP on the basis of CT findings and categorized them according to the absence (Group 1: 73 patients) or presence (Group 2: 43 patients) of malignancy. Patient age and sex, diameter, size, mass effect, location, and fat density of the MP mass, presence of a pseudocapsule and/or halo sign, and lymph node status were compared between the two groups. Results MP tends to be more common in males, and this trend shows statistical significance when combining the findings for both groups (P=0.041). Patients in Group 1 were significantly younger than those in Group 2 (54.29 vs 64.77 years, P=0.001). A well-defined fatty mass at the small bowel root was observed in all patients. The halo sign was present in most cases in both groups. A pseudocapsule was observed in 36 patients (49%) in Group 1 and 29 (67%) in Group 2 (P=0.045). The average craniocaudal diameter of the MP masses on the sagittal view was 11.14 and 12.5 cm in Groups 1 and 2, respectively (P=0.005). The MP fat density was less negative in patients with malignancy (–66 vs –76 HU, P=0.001). Lymph node status was similar in both groups. Conclusion Detailed CT features should be evaluated in patients with MP, as some of these features may indicate an associated malignancy, necessitating further investigation and close follow-up.
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Affiliation(s)
- Mamoon H Al-Omari
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Khaleel Qararha
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Mohammed Garaleh
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Mahmoud M Smadi
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Bani Hani
- Department of Surgery, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Mwaffaq Elheis
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
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Elevated CA-125 in IgG4 mesenteritis: a red herring or a disease biomarker? Case report and literature review. Rheumatol Int 2018; 39:1285-1289. [PMID: 30143819 DOI: 10.1007/s00296-018-4145-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
Mesenteric panniculitis (MP) is a rare chronic disease characterized by inflammation and subsequently fibrosis of adipose tissue of the omentum. Only recently it has been associated with IgG4-related disease. Cancer antigen 125 (CA-125) is a high-molecular mass glycoprotein, traditionally associated with ovarian cancer, although it can be elevated in other conditions. Herein we describe a case of a 56-year-old man with IgG4 related mesenteric panniculitis associated with very high levels of CA-125 at the onset of disease. The CA-125 levels corresponded to clinical disease activity and improved with steroid therapy and rituximab. A literature review was performed concerning possible association of MP, IgG4-related disease and CA-125. The review of literature suggests that high levels of CA-125 can be raised in non-malignant, inflammatory conditions including IgG4-related mesenteritis and can improve with treatment.
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