A case report of mesenteric panniculitis

Abstract

A 65-year-old man had intermittent abdominal pain for the previous 2 years. This pain suddenly became worse with a fever and elevated inflammatory markers. We took a while to diagnose the patient with mesenteric panniculitis (MP). Although imaging findings suggested MP, we needed to rule out other diseases. Choosing a treatment for the patient also took some time and we finally used glucocorticoid to cure the patient.

Mesenteric Panniculitis with Raised Alanine Transaminase Levels: A Rare Case Report from Pakistan

“…The histopathological findings supplement those of the CT scan, broadly comprising of fibrosis, chronic inflammation, and fat necrosis, to variable degrees [5]. The radiological prevalence of the rare condition of MP is reported at 0.16-7.80% with a predisposition for middle and late adulthood (most common in the 50-60 years age group) and a male-to-female ratio of 1.5-1.8:1.0 [3,5]. Although few data are available on the clinical outcomes and response to therapy of patients with MP, the natural course is often benign and self-limiting [5].…”

“…Patients with MP have varying clinical manifestations and most experience no discomfort at all. Clinical presentations, when present, vary according to the stage of the disease and may include abdominal pain, weight loss, nausea, and vomiting or, more specifically, an abdominal mass, peritonitis, peritoneal irritation, and ascites [1,3]. The etiology of MP remains unknown; it may occur independently or in association with other disorders.…”

“…Various causes have been suggested, including autoimmune disorders, infection, trauma (including recent surgery), and ischemia of the mesentery. The condition has a poorly understood link with underlying malignancy as well, which implies its potential paraneoplastic nature, at least in some of the patients [3].…”

Mesenteric Panniculitis in A Patient with Dengue Fever

“…It is noteworthy, in our case, all of the features were present in CT abdomen. Other features in CT abdomen are fibrotic or inflammatory soft tissue mass with adenopathy occasionally encasing vessels with thrombosis, calcifications due to adipose tissue necrosis, pseudocapsule, and so on 7,8 . Biopsy (through laparoscopy or laparotomy) is the gold standard to diagnose.…”

“…If fibrosis is dominant, it is called retractile mesenteritis; if mesenteric inflammation is dominant, it is called mesenteric panniculitis 2,10 . However, biopsy is not always necessary for diagnosis, and typical cases can be directly diagnosed without pathological biopsy 8 . Recently mesenteric panniculitis has been diagnosed using CT features of the disease 3,8 Mesenteric panniculitis can be resolved spontaneously with a good prognosis 2,8 ; hence observation is advised for asymptomatic patients.…”