[Mesenteric panniculitis as the initial manifestation of a B cell lymphoma]

Mesenteric panniculitis is an uncommon clinical entity which sometimes may be associated with hematologic, gastrointestinal and urological neoplasms. The diagnostic procedure ofchoice is based on obtaining a tissue sample for histopathological study usually through apercutaneous procedure. Treatment is indicated in symptomatic cases.

Guanylin-Guanylyl cyclase-C signaling in macrophages regulates mesenteric fat inflammation induced by high-fat diet

Guanylin (Gn), a bioactive peptide, and its receptor, guanylyl cyclase-C (GC-C), are primarily present in the intestine and maintain homeostasis in body fluids. Recently, rats whose macrophages overexpress Gn and GC-C were found to be resistant to diet-induced obesity. Considering that obesity is strongly related to a chronic inflammatory state in white adipose tissues, it is possible that Gn-GC-C macrophages contribute to the regulation of inflammation. In the present study, we investigated the inflammatory state of mesenteric fat in rats transgenic for both Gn and GC-C (double-transgenic [dTg] rats) by evaluating the levels of cyclic guanosine monophosphate (cGMP), a second messenger of Gn-GC-C, cGMP-dependent protein kinase (PKG), and phosphorylated vasodilator-stimulated phosphoprotein (VASP), a target protein of PKG. The levels of cGMP in dTg rats was higher than in WT rats fed the same diet. Although there were no significant differences in levels of PKG and phosphorylated VASP between WT and dTg rats fed a standard diet (STD), these levels in dTg rats fed a high fat diet (HFD) were markedly increased compared with levels in HFD WT rats. Furthermore, mRNA levels of proinflammatory factors in mesenteric fat were lower in HFD dTg rats than in HFD WT rats and were similar to levels in STD WT and dTg rats. These results indicate that the Gn-GC-C system in macrophages regulates the cGMP-PKG-VASP pathway and controls obesity through the downregulation of proinflammatory factors.

[Successful endoscopic transpapillary pancreaticobiliary drainage for omental panniculitis by hepatocellular carcinoma complicated by biliary fistula and pancreatic fistula]

A 78-year-old man with hepatocellular carcinoma treated by chemoembolization and percutaneous ethanol injection was admitted to our hospital because of acute abdomen. The CT scan showed biliary fistula caused by hepatocellular carcinoma protruding from S3. Endoscopic retrograde cholangiopancreatography showed disruption of an intrahepatic duct and the main pancreatic duct, and contrast agent leaked into the peritoneal cavity from each duct. Omental panniculitis with biliary fistula and pancreatic fistula was diagnosed. The symptoms improved by endoscopic nasobiliary drainage and endoscopic pancreatic stenting. On the 13th day after admission, we added endoscopic nasopancreatic drainage because his abdominal pain had been exacerbated by pancreatic juice leakage. Omental panniculitis by hepatocellular carcinoma complicated by biliary fistula and pancreatic fistula is extremely rare. Endoscopic transpapillary pancreaticobiliary drainage was effective for omental panniculitis in this case.

[Retractile mesenteritis: case report]

The Authors report a case al retractile mesenteritis. The disease is a chronic inflammation of the mesentery with the developement of fibrosis. The mesenteritis is a benign disease and sometimes it is related to urogenital neoplasm. The CT fìndings of mesenteritis are non specific and often is necessary a laparotomic or laparoscopic biopsy. The therapy in uncomplicated cases is steroid treatment.

[Sclerosing mesenteritis. Presentation of three cases and review of the literature]

Sclerosing mesenteritis or panniculitis is a rare condition characterized by inflammation of the mesentery ranging from an acute to a chronic fibrotic process that can resemble an intestinal malignant neoplasm even though it is benign. Its etiology is unknown, although it is thought to be the result of a nonspecific inflammatory response of the mesentery to an allergic, chemical, thermal, infectious, autoimmune or surgical stimulus. Its natural history is benign and in most cases is self-limited. Surgery is reserved only for those cases where there is intestinal obstruction. We report three cases of sclerosing mesenteritis that occurred after abdominal surgery and we present a review of the literature.

Mesenteric lipodystrophy of the left colon

Mesenteric lipodystrophy is a rare condition characterized by tumor-like expansion of the mesocolon. The etiology remains obscure, but autoimmunity, abdominal trauma, abdominal surgery, and ischemic injury have all been postulated. To our knowledge, there have been no previous reports of synchronous mesenteric lipodystrophy and angiodysplasia. Whether these are independent or associate entities remains unknown. We present the clinical, radiological, and pathological findings of such a case.

[Etiologic spectrum of mesenteric panniculitis: report of 7 cases]

OBJECTIVE

Mesenteric panniculitis is a rare disorder characterized by nonspecific inflammation and/or necrosis and/or fibrosis in the adipose tissue of the bowel mesentery. Its signification, primary or associated with other diseases, is a subject of controversy.

METHODS

A descriptive and retrospective study of patients with an abdominal CT examination showing features of mesenteric panniculitis and for whom biopsy with immunohistochemical examination was obtained in all cases.

RESULTS

Seven patients were enrolled (4 men and 3 women) with a median age of 62,1 years. None of the patients without an identified etiology had a history of abdominal surgery. An associated disease was identified in 4 cases: breast cancer (1), non-Hodgkin's lymphoma based on peripheric lymph nodes biopsy (2) and cryoglobulinemic vascularitis based on renal biopsy (1). In the 3 remaining cases, isolated mesenteric panniculitis was the only abnormality despite thorough imaging and pathologic investigations.

CONCLUSION

Except an obvious malignancy context or a history of abdominal surgery, a pathologic examination of the mesenteric panniculitis lesions is necessary, especially to eliminate another mesenteric disorder. Mesenteric panniculitis is often associated with lymphoma.

[Two cases of mesenteric panniculitis]

Two patients with mesenteric panniculitis are presented. In the first patient, a provisional diagnosis of ileus was made, based on the clinical features and imaging data. Laparotomic findings showed that the ileum was bound tightly by a fibrous strip and dilated, with thickened and swollen mesentery. Incision of the fibrous strip was performed, and the clinical symptoms were improved. The second patient was strongly suspected to have mesenteric panniculitis, from characteristic features on abdominal computed tomography and barium enema. Conservative therapy was effective in this case. We emphasize the variety of clinical courses in mesenteric panniculitis, requiring selection of the most suitable treatment.

[Post-operative sclerosing mesenteritis]

For the first time we describe a sclerosing mesenteritis that appeared acutely after abdominal operations. The patient suffered from diffuse abdominal symptoms. There was a hard tumour in the left middle and lower abdomen. Histological analysis revealed fibrosis and bone tissue. Symptoms improved after application of prednisone and high-calorie infusions.

[Minimally invasive technologies in diagnosis and treatment of local purulent complications of destructive pancreatitis]

Sixty patients with local purulent complications of destructive pancreatitis were treated. Interventional procedures under visual control were performed in 38 patients: in 26 (68.4%) -- under control of computed tomography and in 12 (31.6%) -- ultrasound-assisted procedures. Traditional surgeries were performed in 22 patients. Complete recovery was seen in 23 (60,6%) of 38 patients of the first group, all these patients have solitary, one-chamber and non-sequestered purulent cavities which are formed in 82.6% cases due to microfocal pancreonecrosis. Transcutaneous drainage was ineffective in 14 (36.8%) patients that required conversion to laparotomy. It is demonstrated that treatment policy in purulent-necrotic complication of pancreonecrosis must be individual. Adequate method of local treatment must be determined by size and localization of purulent and necrotic lesions, presence of sequesters and septa.

[Mesenteric panniculitis. Aspects in x-ray computed tomography and MRI]

We report one case of mesenteric panniculitis. This rare and poorly-known disease is characterized by a non specific inflammatory process involving adipose tissue of the mesentery. The new imaging techniques (CT and MRI) may be helpful for the diagnosis of this disease and allow avoiding laparotomy. However histological proof remains necessary and can be given by guided needle biopsy.

Mesenteritis secondary to the use of a pneumatic jackhammer

Mesenteritis is an uncommon condition characterized by a variable clinical course, in which spontaneous remission may occur, but in which uncontrollable disease activity leads to death [corrected]. We describe a construction worker with mesenteritis who presented with vague abdominal discomfort and mucoid diarrhoea. A large, irregular mass was found in the abdomen. Upon explorative laparotomy, a large, rubbery, grey and yellow, irresectable tumorous mass was found, which apparently originated from the mesentery of the small bowel. The large bowel was expanded over the tumorous mass. A defunctioning colostomy was made. Histologic examination of biopsy specimens revealed only fatty necrosis of the mesentery and no evidence of malignancy. It is assumed that a pseudotumour of the mesentery had developed after chronic repetitive abdominal trauma caused by the continuous vibration of a pneumatic jackhammer, on which the patient pressed his abdomen during construction work. In this case of mesenteritis, the clinical course was one of spontaneous and complete recovery.

[Relapsing polychondritis and mesenteric panniculitis: apropos of 2 cases]

We report two cases of polychondritis associated with mesenteric panniculitis. Case 1. In February 1989, a woman born in 1949 presented with 40 degrees C fever accompanied by pain in the abdomen and pelvis. Eight days later, nodular skin lesions appeared on her lower limbs. The abdomen was swollen with gas and undepressible. An abdominal CT scan revealed partitioned peritoneal collections, and a guided needle aspiration produced a chylous fluid. Direct and indirect bacteriological examinations gave negative results. Histology showed intense inflammatory reaction with giant cells and lipophages, thereby confirming the presence of mesenteric panniculitis. Six months later, the development of chondritic lesions on the nose and the helix of the ear clinched the diagnosis of polychondritis. The patient was put on corticosteroid therapy for a few months, and in January this year (1993) she is durably asymptomatic. Case 2. In October 1977, a woman born in 1937 presented with polychondritis with prolonged fever, inflammatory syndrome and chondritic lesions of the nose, larynx and helix of the ear. In December 1978, she developed signs of abdominal obstruction. Laparotomy revealed infiltration by multiple nodular formations of the entire posterior line of attachment of the mesentery. Biopsies withdrew a puriform fluid. Histology showed a partly necrotic adipose tissue with giant cells and lipophages. High-dose corticosteroid therapy partially controlled the chondritic and abdominal manifestations. The occurrence of abdominal pain in patients with polychondritis may result from several disorders, such as iatrogenic complications, digestive tract vasculitis or ulcerative colitis, but also associated mesenteric panniculitis.