Sclerosing Mesenteritis, Mesenteric Panniculitis and Mesenteric Lipodystrophy: A Single Entity?

Emory, Theresa S.; Monihan, James M.; Carr, Norman J.; Sobin, Leslie H.

doi:10.1097/00000478-199704000-00004

Cited by 314 publications

(427 citation statements)

References 27 publications

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“…Panniculitis of the Mesentery komponent olması halinde hastalığın "retraktil mezenterit" olarak adlandırıldığı bildirilmiştir (10)(11)(12)(13). Mezenterik pannikülitin etyolojisi net olmamakla beraber ilişkilendirildiği pek çok hastalık vardır.…”

Section: Discussionunclassified

Panniculitis of the Mesentery

Başol¹,

Taş²,

Ayan³

et al. 2013

JAEMCR

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The mesentery is the double layer of peritoneum that suspends the small intestine (jejunum and ileum) from the posterior wall of the abdomen. The superior mesenteric artery and its branches, accompanying veins, lymphatic, lymph nodes, the autonomic nerve plexuses, with a larger amount of connective tissue and varying amounts of fat tissue around the root of the mesentery, are located between two layers of peritoneum. Mesenteric panniculitis is a benign disorder that characterised by fat necrosis, chronic inflammation, and fibrosis. Although the aetiology is not clear, it is associated with many diseases, such as previous abdominal surgery, and malignancies. Mesenteric panniculitis may be asymptomatic or accompanied by symptoms such as abdominal pain, abdominal distention, palpable mass, and fever. Laboratory tests are non-specific in diagnosis. Although diagnosis of the disease is usually with ultrasound and abdominal CT is definitive, diagnosis is made by histopathological examination. Usually, symptomatic treatments are administered in mesenteric panniculitis; however, immunosuppressive agents or steroids have also been reported to be effective. In this study, we report three cases admitted to the emergency room with abdominal pain and diagnosed as mesenteric panniculitis, to draw attention to the cause of this rare abdominal pain.Keywords: Mesentery, panniculitis, abdominal pain Received: 07.04.2012 Accepted: 28.04.2012 ÖZET Peritonun çift katlı tabakası olan mezenterium ince bağırsakları (jejunum ve ileum) karın arka duvarına asar. Mezenterin her iki yüzünde peritonun çift katmanı arasında a.mesenterica superior ve dalları, bunlara eşlik eden venler, lenfatikler, lenf düğümleri, otonom sinir pleksusları, bağ dokusu ve kök civarında daha büyük miktarda bulunan değişik miktarlarda yağ dokusu vardır. Mezenterik pannikülit; yağ nekrozu, kronik inflamasyon ve fibrozis ile karakterize iyi huylu bir hastalıktır. Etiyolojisi net olmamakla birlikte geçirilmiş abdominal cerrahi, malignensiler gibi ilişkilendirildiği pek çok hastalık mevcuttur. Mezenterik pannikülit, semptomsuz seyredebileceği gibi karın ağrısı, abdominal distansiyon, ele gelen kitle, ateş gibi semptomlarla da seyredebilir. Tanısında Laboratuvar tetkikleri non spesifiktir. Tanısı genelde USG ve batın BT ile konulsa da kesin tanıya histopatolojik incelemeler neticesinde ulaşılır. Mezenterik pannikülit de genellikle semptomatik tedaviler uygulanmakla birlikte immünsüpresif ajanlar yada steroidlerin etkili olduğu da bildirilmiştir. Bu çalışmada biz acil servise karın ağrısı şikayeti ile başvuran ve mezenterik pannikülit tanısı konulan üç olguyu sunduk, böylelikle karın ağrısının bu nadir sebebine dikkat çekmek istedik. GirişKarın ağrısı acil servise başvuruların yaklaşık %5-10'luk önemli bir kısmını oluşturan bir durumdur (1). Hastaların %20-25'inde başvuru sonrası hastaneye yatış gerekirken, %35-40'ında ise yapılan tetkiklere rağmen hiçbir patolojinin saptanmadığı, ağrının genellikle kendiliğinden sonlandığı ve nonspesifik karın ağrısı olarak de...

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Section: Discussionunclassified

Panniculitis of the Mesentery

Başol¹,

Taş²,

Ayan³

et al. 2013

JAEMCR

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“…These latter two findings are not seen in other mesenteric diseases such as lipoma, lymphoma, or liposarcoma. 4 …”

Section: Diagnosismentioning

confidence: 99%

Sclerosing Mesenteritis: Clinical Presentation, Imaging Findings, and Treatment

Nauheim¹,

Onyeali²

2018

TMF

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A 67-year old male with a history of myocardial infarction status post percutaneous coronary intervention and stage IV bladder cancer status post radical cystoprostatectomy with ileal neobladder reconstruction and chemotherapy (cisplatin and gemcitabine) presented with progressive, severe epigastric and lower abdominal pain associated with nausea. The pain had intensified over the previous week and was associated with a recent fifteen pound weight loss in the setting of poor oral intake. He denied nausea or diarrhea.His physical exam was notable for abdominal tympany and tenderness. His labs were notable for mild hyperkalemia (potassium 5.0 mmol/L), normal white blood cell count, lipase of 28 U/L, normal liver function tests, and positive 2+ leukocyte esterase and 1+ blood in his urine. Upper endoscopy showed a small Schatzki's ring in the distal third of the esophagus with small hiatal hernia and gastritis. On CT, there was thickened, indurated mesentery and a mesenteric mass (Figure 1) with abdominal lymphadenopathy and a new adrenal nodule. EPIDEMIOLOGY & CLINICAL PRESENTATIONSclerosing mesenteritis, also known as mesenteric panniculitis, is part of a spectrum of idiopathic primary inflammatory and fibrotic processes that affect the mesentery and is characterized by inflammation of mesenteric fat. Although its etiology is unclear, it has been associated with previous abdominal surgery, autoimmunity, paraneoplastic syndromes, ischemic injury, and infection. Sclerosing mesenteritis is also associated with a high prevalence of coexisting malignancies and future cancer development. 1 In a study evaluating 7620 patients presenting with a chief complaint of abdominal pain, the prevalence was 0.6%. 2 The presentation of sclerosing mesenteritis is variable. In a series of 68 patients with sclerosing mesenteritis, 75% had abdominal pain, 26% had nausea/vomiting, 20% had anorexia and weight loss, and 20% had altered bowel habits. 3 In an 84-patient cohort, only 35% had abdominal pain, and 20% had an incidental abdominal mass on exam. 2 The duration of symptoms ranged from 24 hours to 2 years. 2 Up to 20% of patients with sclerosing mesenteritis develop complications, often intestinal obstruction from mass effect. 3 Other complications include mesenteric vascular occlusion, chylous ascites, and adverse effects from medications used to treat sclerosing mesenteritis.

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“…Durst et al stated that the recent surgery was related to 17% of its cases, constituting a predisposing factor [12]. Abdominal surgeries more commonly described, cholecystectomy, appendectomy, hysterectomy and colectomy [5,6].…”

Section: Pathogenesismentioning

confidence: 99%

“…Some investigators report spontaneous resolution of disease, and others describe the curative resection and laparotomy is clearly indicated in the case of sclerosing mesenteritis, associated bowel obstruction nonresolving [12,[29][30][31][32][33].…”

Section: Treatmentmentioning

confidence: 99%

Sclerosing Mesenteritis-Update on Diagnostic and Therapeutic Approach

Garcia¹,

Oliveira²

2016

Transl Biomed

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The sclerosing mesenteritis (SM) is a rare, non-specific inflammatory condition, mainly affecting the benign intestinal mesentery. It is known that she is diagnosed mainly during the sixth and seventh decade of life and seems to be two times more common in men than in women. The etiology of SM remains unknown, although several mechanisms have been suggested contributors, including surgery or abdominal trauma before, autoimmunity, paraneoplastic syndrome, ischemic injury and infections. The major signs and symptoms are abdominal pain, presence of palpable abdominal mass, nausea and vomiting, bowel changes, weight loss, small bowel obstruction, chylous ascites and peritoneal irritation signals. About of 10% of the patients are asymptomatic. The radiological study, especially computed tomography (CT) and magnetic resonance imaging (MRI) are essential components in the diagnostic evaluation. The ''greasy'' ring signal and the pseudocapsule tomographic findings are considered specific tumoral this pathology. The diagnosis is established by histopathologic study. There is no specific treatment for SM and should this be empirical and individualized. Although they are described cases of spontaneous remission, some authors have shown benefit with the empirical treatment using corticosteroids, colchicine, immunosuppressants, antibiotics, tamoxifen, alone or in combination. The surgical approach has a limited role and usually aimed at symptomatic relief. In most cases, the prognosis is favorable.

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Sclerosing Mesenteritis, Mesenteric Panniculitis and Mesenteric Lipodystrophy: A Single Entity?

Cited by 314 publications

References 27 publications

Panniculitis of the Mesentery

Panniculitis of the Mesentery

Sclerosing Mesenteritis: Clinical Presentation, Imaging Findings, and Treatment

Sclerosing Mesenteritis-Update on Diagnostic and Therapeutic Approach

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