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Azam MB, Senthamizhselvan K, Jose A, Govindarajalou R. Sclerosing mesenteritis as a cause of porto-mesenteric vascular obstruction. BMJ Case Rep 2024; 17:e260802. [PMID: 39142845 DOI: 10.1136/bcr-2024-260802] [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] [Indexed: 08/16/2024] Open
Abstract
A woman in her 20s presented with haematemesis, post-prandial abdominal pain, weight loss and anaemia. Imaging revealed a non-enhancing mass in the retroperitoneal space along the mesenteric plane, encasing the porto-mesenteric vasculature. Endoscopy showed oesophageal varices. She was diagnosed with sclerosing mesenteritis, causing extrinsic compression of the portal vein and superior mesenteric artery. She underwent endoscopic variceal ligation and received prednisolone and tamoxifen. After 3 months, her post-prandial pain improved, and she did not have further bleeding episodes.
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Affiliation(s)
- Mohammed Bilal Azam
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kuppusamy Senthamizhselvan
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Augustine Jose
- Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramkumar Govindarajalou
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Dadkhah A, Jafari S, Bagheri SM, Ebrahimi A. Association between mesenteric panniculitis and urolithiasis. Emerg Radiol 2024:10.1007/s10140-024-02255-9. [PMID: 38969913 DOI: 10.1007/s10140-024-02255-9] [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: 03/01/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Mesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat. OBJECTIVES This study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis. MATERIALS AND METHODS In this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation. RESULTS Mesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis. CONCLUSION Mesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.
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Affiliation(s)
- Adeleh Dadkhah
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Hazrate Rasoul Akram Hospital, Niyayesh St, Shahrara, Tehran, Iran
| | - Sedigheh Jafari
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Bagheri
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Hasheminejad Kidney Center (HKC), University of Medical Sciences, Tehran, Iran
| | - Azin Ebrahimi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department of Radiology, Hazrate Rasoul Akram Hospital, Niyayesh St, Shahrara, Tehran, Iran.
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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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Ng TTW, Davel S, O’Connor KD. Sulfasalazine-Induced Delayed Hypersensitivity Reaction Presenting as Fever, Aseptic Meningitis, and Mesenteric Panniculitis in a Patient with Seronegative Arthritis. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941623. [PMID: 37924204 PMCID: PMC10630587 DOI: 10.12659/ajcr.941623] [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: 06/29/2023] [Revised: 09/26/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND An 82-year-old woman presented with acute pyrexial illness and mesenteric panniculitis and developed biochemical aseptic meningitis (cerebrospinal fluid pleocytosis with no identifiable pathogen). Investigation determined her illness was likely a delayed hypersensitivity reaction caused by sulfasalazine. Sulfasalazine-induced aseptic meningitis is a rare condition often diagnosed late in a patient's admission owing to initial non-specific illness symptomatology requiring the exclusion of more common "red flag" etiologies, such as infection and malignancy. CASE REPORT An 82-year-old woman with a history of recurrent urinary tract infections and seronegative arthritis presented with a 3-day history of fatigue, headache, dyspnea, and lassitude. On admission, she was treated as presumed sepsis of uncertain source owing to pyrexia and tachycardia. Brain computer tomography (CT) revealed no acute intracranial abnormality. Furthermore, CT of the chest, abdomen, and pelvis did not reveal any source of sepsis or features of malignancy. After excluding infective etiologies with serological and cerebrospinal fluid testing, sulfasalazine-induced aseptic meningitis (SIAM) was diagnosed. The patient was then commenced on intravenous steroids, resulting in immediate defervescence and symptom resolution. CONCLUSIONS SIAM remains a diagnostic challenge since patients present with non-specific signs and symptoms, such as pyrexia, headaches, and lassitude. These patients require a thorough investigative battery starting with anamnesis, physical examination, biochemical testing, and radiologic imaging. This case illustrates the need for a high suspicion index of drug-induced hypersensitivity reaction in a rheumatological patient with pyrexial illness where infective etiologies have been confidently excluded. Prompt initiation of intravenous steroids in SIAM provides a dramatic recovery and resolution of symptoms.
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Affiliation(s)
- Tristen Tze Wei Ng
- Department of General Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia
- Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sue Davel
- Department of General Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Kevin David O’Connor
- Stroke Unit, Joondalup Health Campus, Joondalup, Western Australia, Australia
- Department of Immunology, Royal Perth Hospital, Perth, Western Australia, Australia
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Inverted FDG Uptake Pattern in Subcutaneous Panniculitis-Like T-Cell Lymphoma. Clin Nucl Med 2023; 48:186-187. [PMID: 36607368 DOI: 10.1097/rlu.0000000000004451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT A 47-year-old woman presented with a 2-month history of subcutaneous nodules, erythema, and fever. 18F-FDG PET images demonstrated inverted FDG uptake pattern corresponding to the subcutaneous lesion against lymph nodes. The specimen of the inguinal lesion showed massive infiltration of small lymphocytes in the adipose tissue with rimming adipocytes, whereas very few tumor cells infiltrated the lymph nodes. Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) was diagnosed. SPTCL normally shows quite interesting distribution of tumor cells, that is, lymph node involvement is usually absent. Therefore, this case highlighted the importance of the inverted accumulation pattern on FDG PET to suspect SPTCL.
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Barrington SF, Mir F, El-Galaly TC, Knapp A, Nielsen TG, Sahin D, Wenger M, Kostakoglu L, Trotman J, Meignan M. Follicular Lymphoma Treated with First-Line Immunochemotherapy: A Review of PET/CT in Patients Who Did Not Achieve a Complete Metabolic Response in the GALLIUM Study. J Nucl Med 2022; 63:1149-1154. [PMID: 34857656 PMCID: PMC9364340 DOI: 10.2967/jnumed.121.262869] [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: 07/08/2021] [Accepted: 11/09/2021] [Indexed: 02/03/2023] Open
Abstract
Complete metabolic response (CMR) on PET/CT was the sole independent predictor of overall survival in the PET substudy of the phase III GALLIUM trial (NCT01332968) in first-line treatment of high-tumor-burden follicular lymphoma. The aim of this analysis was to further investigate the outcome of patients not achieving CMR. Methods: Two international experts rereviewed PET/CT scans from patients failing to achieve CMR assessed by the Independent Review Committee masked otherwise to committee results. Metabolic response category and Deauville score were assigned. Progression-free survival (PFS) was investigator-assessed with contrast-enhanced CT. Kaplan-Meier methodology was used to estimate landmark PFS and time to next treatment from end of induction by Deauville score. Patients who experienced CT-based progressive disease at the end of induction were excluded. Results: Fifty-four patients were reviewed. Six had CMR, 37 had a partial metabolic response, 2 had no metabolic response, and 9 had progressive metabolic disease. Patients were reassigned to CMR because 18F-FDG uptake was considered inflammatory (n = 2), was considered incidental neoplasia (n = 2), or was visually close to liver uptake but quantitatively lower (n = 2). There was a trend for shorter PFS and time to next treatment for patients with a Deauville score of 5 than a score of 4. High-grade mesenteric uptake at the end of induction was common, occurring in 20 patients with non-CMR, 14 of whom achieved CMR at all other sites. Only 3 of 14 (21%) patients with mesenteric uptake as the only site of disease experienced progression or death within 24 mo, whereas 4 of 6 patients (67%) with mesenteric and additional sites of 18F-FDG-avid disease experienced progression or death within 24 mo. All patients with early progression had measurable disease on contrast-enhanced CT at 18F-FDG-avid sites at the end of induction. Conclusion: After induction immunochemotherapy, CMR was assigned after reassessment in some patients, in whom increased 18F-FDG uptake was considered due to inflammation or incidental neoplasia rather than to lymphoma. Quantitative assessment to confirm the visual impression of residual uptake in lesions is suggested. Isolated mesenteric 18F-FDG uptake is likely a common false-positive finding at the end of induction and does not warrant changes in clinical management or disease surveillance unless there is measurable disease on contrast-enhanced CT or clinical suspicion of active disease.
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Affiliation(s)
- Sally F. Barrington
- School of Biomedical Engineering and Imaging Sciences, King’s College London and Guy’s and St. Thomas’ PET Centre, King’s College London, King’s Health Partners, London, United Kingdom
| | - Farheen Mir
- Department of Haematology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Andrea Knapp
- Product Development Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Tina G. Nielsen
- Product Development Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Denis Sahin
- Product Development Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Michael Wenger
- Pharma Development Oncology, Genentech Inc., South San Francisco, California
| | - Lale Kostakoglu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - Judith Trotman
- Hematology Department, Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia; and
| | - Michel Meignan
- LYSA Imaging, Hôpitaux Universitaires Henri Mondor and Université Paris–Est Créteil, Créteil, France
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Wagner C, Dachman A, Ehrenpreis ED. Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition. Clin Colon Rectal Surg 2022; 35:342-348. [PMID: 35966977 PMCID: PMC9365492 DOI: 10.1055/s-0042-1743588] [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: 11/03/2022]
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.
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Affiliation(s)
- Christopher Wagner
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Abraham Dachman
- Department of Radiology, University of Chicago Hospital, Chicago, Illinois
| | - Eli D. Ehrenpreis
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
- Department of Medicine, Rosalind Franklin University Medical School, North Chicago, Illinois
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8
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Suda T, Oishi N, Kobayashi M. Primary Follicular Lymphoma in the Small Intestine: A Rare Cause of Bowel Obstruction. Mayo Clin Proc 2022; 97:1209-1210. [PMID: 35662433 DOI: 10.1016/j.mayocp.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Tsuyoshi Suda
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan.
| | - Naoki Oishi
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
| | - Masako Kobayashi
- Department of Pathology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
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9
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Láinez-Ramos-Bossini AJ, Gómez-Huertas M, Gálvez-López R. Mesenteric panniculitis and abdominal pain: A casual association? Retrospective case series analysis. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45 Suppl 1:143-144. [PMID: 33545236 DOI: 10.1016/j.gastrohep.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/14/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Jesús Láinez-Ramos-Bossini
- Sección de Radiología Abdominal, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Radiología, Universidad de Granada, Granada, España.
| | - María Gómez-Huertas
- Sección de Radiología Abdominal, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Regina Gálvez-López
- Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, España
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Liu C, Lee M, Tung C, Tsai K, Chen C, Chou C. Primary mesenteric follicular lymphoma with mesenteric panniculitis—A rare differential diagnosis of abdominal pain. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Che‐Yu Liu
- Department of Internal MedicineDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
| | - Ming‐Yang Lee
- Department of Internal MedicineDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Division of Oncology and HematologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Min‐Hwei Junior College of Health Care Management Tainan Taiwan
| | - Chun‐Liang Tung
- Department of PathologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Department of Food Nutrition and Health BiotechnologyAsia University Taichung Taiwan
| | - Kun‐Feng Tsai
- Department of Internal Medicine, Gastroenterology and Hepatology Section, An‐Nan HospitalChina Medical University Taichung Taiwan
- Department of Internal MedicineNational Taiwan University College of Medicine and National Taiwan University Hospital Taipei Taiwan
| | - Chi‐Yi Chen
- Division of Gastroenterology and HepatologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
| | - Chu‐Kuang Chou
- Division of Gastroenterology and HepatologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Clinical Trial CenterDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
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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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Watanabe T, Terai S, Tsukada T, Takeshita M, Matsui K, Amaya K, Kaji M, Maeda K, Shimizu K, Saito J, Mochizuki K, Uchiyama A. Sclerosing mesenteritis mimicking metachronous peritoneal metastases from descending colon adenocarcinoma. World J Surg Oncol 2017; 15:142. [PMID: 28764712 PMCID: PMC5540343 DOI: 10.1186/s12957-017-1214-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Sclerosing mesenteritis is a non-neoplastic inflammatory disease that occurs in the bowel mesentery. Distinguishing sclerosing mesenteritis from neoplasms may be difficult because of the clinical and radiographic similarities between the two disease entities. Case presentation We report a case of sclerosing mesenteritis mimicking peritoneal metastases of colorectal carcinoma. A 73-year-old man with stage II descending colon adenocarcinoma with poor prognostic features was found to have developed left lower abdominal quadrant masses on computed tomography (CT) 9 months after undergoing radical surgery. These masses were diagnosed as peritoneal metastases because they grew in size and displayed fluorodeoxyglucose (FDG) uptake 3 months later; thus, a laparotomy was performed. The masses, which were localized in the jejunal mesentery, were excised completely via segmental jejunal resection. Histopathological analysis confirmed that the masses were sclerosing mesenteritis. The patient showed no signs of sclerosing mesenteritis or colorectal carcinoma recurrence during follow-up. Conclusions In patients suspected of having localized peritoneal metastasis from malignancies, any masses must be sampled by surgical excisional biopsy and subsequently examined to rule out alternative diagnoses, such as sclerosing mesenteritis.
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Affiliation(s)
- Toshifumi Watanabe
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan.
| | - Shiro Terai
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Masaki Takeshita
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koshi Matsui
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koji Amaya
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Kiichi Maeda
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Koichi Shimizu
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Junko Saito
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Kentaro Mochizuki
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
| | - Akio Uchiyama
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78 Toyama, Toyama, 9308550, Japan
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Synchronous association of typical and transient mesenteric panniculitis with acute gastrointestinal attack of adult-onset Henoch-Schönlein purpura. Diagn Interv Imaging 2017; 98:571-573. [PMID: 28347643 DOI: 10.1016/j.diii.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/21/2022]
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15
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Sahin A, Artas H, Eroglu Y, Tunc N, Demirel U, Bahcecioglu IH, Yalniz M. An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis. Med Princ Pract 2017; 26:567-572. [PMID: 29073610 PMCID: PMC5848480 DOI: 10.1159/000484605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/26/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of mesenteric panniculitis (MP) and to describe its clinical characteristics, therapy, and outcome. SUBJECTS AND METHODS This retrospective study was carried out among patients with MP based on computed tomography (CT) scans from January 2012 to December 2015. The CT images were reanalyzed by study radiologists to confirm the previous MP diagnosis. Patients were divided into 2 groups, i.e., idiopathic and secondary, based on the presence or absence of associated predisposing factors such as trauma, malignancy, autoimmune disorders, ischemia, or previous abdominal surgery. The clinical characteristics of the 2 groups, as well as treatments, were assessed. RESULTS Among the 19,869 CT scans, 36 patients (0.18%) with MP were identified (i.e., 19 [53%] females and 17 [47%] males). The median age was 54 years (range 26 - 76). Twenty-four patients (67%) were categorized into the idiopathic group. Malignancy was the predisposing factor in 8 (22%) of those patients. Furthermore, abdominal pain was the cardinal symptom observed in 22 patients (92%) in the idiopathic group. In the idiopathic group, 15 patients (63%) were treated with antibiotics and 16 (67%) were treated with nonsteroidal anti-inflammatory drugs (NSAID). One unresponsive patient was treated with colchicine. Symptomatic relief was achieved in all of the treated patients. CONCLUSION In this study, a symptomatic idiopathic subgroup of patients with MP did not have any associated disorder. The response to treatment with antibiotics and NSAID was effective in most of the patients. Based on these findings, anti-inflammatory treatments beyond NSAID and surgery should be reserved for patients who are unresponsive to antibiotics and NSAID.
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Affiliation(s)
- Abdurrahman Sahin
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
- *Abdurrahman Sahin, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Yunus Emre Avenue 20, TR-23119 Elazig (Turkey), E-Mail
| | - Hakan Artas
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Yesim Eroglu
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Nurettin Tunc
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Ulvi Demirel
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | | | - Mehmet Yalniz
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
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