Mesenteric Panniculitis - Causes, Diagnosis, and Treatment

Introduction:

Jura, in 1924, described the disease affecting a fold of membrane (mesentery) as retractile mesenteritis. Later, it was named mesenteric panniculitis by Odgen in 1960.

Mesenteric panniculitis also corresponds to the following:

• Sclerosing or retractile mesenteritis.

• Mesenteric lipodystrophy.

• Mesenteric Weber-Christian disease.

• Liposclerotic mesenteritis.

What Is Mesenteric Panniculitis?

The mesentery is a fold of fatty tissue that connects the small bowel (intestine) to the abdominal wall. Mesenteric panniculitis is a rare disease that causes inflammation and tissue damage (necrosis). It also leads to fat globule formation and scarring of the mesenteric tissue.

How Common Is Mesenteric Panniculitis?

Mesenteric panniculitis is a rare disorder, and its prevalence is about 0.16 percent to 3.4 percent. Mesenteric panniculitis is genetic because autoimmune diseases run in the family. Studies have shown that males are more commonly affected than females. Children and adolescents are rarely affected, while the highest occurrence is in older individuals from 60 years to 70 years of age.

What Is Sclerosing Mesenteritis?

A rare and little-known illness called sclerosing mesenteritis causes inflammation and fibrosis (scarring) of the mesentery, the tissue that connects the intestines to the abdominal wall. For those who have sclerosing mesenteritis, there can be significant variations in the prognosis and life expectancy.

Sclerosing mesenteritis can have mild to severe symptoms, and its course is unpredictable but not life-threatening. While some people may have more serious symptoms and complications, others may only have mild discomfort or no symptoms at all.

What Causes Mesenteric Panniculitis?

The exact cause of mesenteric panniculitis is not known. However, the following factors increase the risk of it.

• Injury: Surgery or any injury to the abdomen can lead to the development of mesenteric panniculitis.

• Autoimmune Disease: It occurs when the body's immune system works against its healthy tissue and damages it. Mesenteric panniculitis has symptoms similar to those of fever and fatigue observed in other autoimmune disorders.

• Infection: Such as tuberculosis, typhoid, and syphilis have a strong predisposition to mesenteric panniculitis.

• Neoplasm: The imaging studies in patients with cancer show abnormalities similar to those in mesenteric panniculitis. Lymphoma is associated with various mesenteric abnormalities, and neoplasms of the colon, rectum, and prostate also show consistent features on imaging.

• Others: Disorders like Sjogren's syndrome and retroperitoneal fibrosis are also associated with retractile mesenteritis.

What Are the Signs and Symptoms?

Individuals with mesenteric panniculitis have milder symptoms, and it often resolves on its own. However, a few patients may have severe effects. It includes:

• Abdominal pain occurs due to fat tissue inflammation in the mesentery and the small intestine. The pain is felt in the middle portion of the abdomen or sometimes in other areas (abdomen and pelvis).

• Weight loss.

• Fever.

• Fatigue.

• Nausea.

• Vomiting.

• Anorexia.

• The bowel movements are altered (diarrhea or constipation).

• Abdominal swelling. It occurs due to fluid build-up in the abdominal cavity (ascites).

How Is Mesenteric Panniculitis Diagnosed?

Physical Examination: This is done to assess the abdominal swelling and other symptoms. A detailed family and medical history are taken to determine the existence of any autoimmune disorders, malignancy, etc. It is interlinked with the occurrence of mesenteric panniculitis.

• Blood Examination: It helps to evaluate any alterations in the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). ESR and CRP levels are slightly high in patients with mesenteric panniculitis, and red blood cells are decreased.

• Radiographic Examination: It uses techniques like computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and pelvis to show the following classical signs of retractile mesenteritis.

1. Fat tissue in mesentery shows higher attenuation (increased absorption of passing radiation) than surrounding fat tissues in the abdominal wall and small intestine.

2. The halo sign is characterized by soft nodes surrounded by fatty (adipose) tissue. A false capsule also covers the adipose tissue. It is vital for differentiating mesenteric panniculitis from other disorders.

3. The other features include thickening, calcification, and damage to the mesentery.

4. Mesenteric and pelvic lymph nodes are enlarged and calcified.

5. A biopsy is a surgical procedure of removing a small piece of tissue from a diseased organ to study. It confirms the diagnosis of mesenteric panniculitis and eliminates other possible conditions.

What Are Similar Disorders?

Whipple's Disease: A disorder caused by a bacterial infection that disturbs the normal digestion and absorption of fats and carbohydrates and affects the joints. It leads to weakness, weight loss, diarrhea, ankle and knee swelling, severe stomach pain, and cramps. Other symptoms include fever and enlarged lymph nodes.

• Crohn's Disease: Is an inflammatory disorder of the digestive tract, mainly the small and large intestines. The symptoms can be mild or severe, and they occur during periods when the patient may not have symptoms at times. The symptoms include diarrhea, abdominal pain, fever, fatigue, blood in stool, and weight loss.

• Gastrointestinal Lymphoma: Is a malignancy of the lymphatic system (lymph vessels, nodes, bone marrow, spleen, and thymus) and affects organs in the gastrointestinal tract, especially the stomach. It causes abdominal pain, weight loss, nausea, vomiting, indigestion, etc.

How Is Mesenteric Panniculitis Treated?

In asymptomatic patients, regular monitoring with abdominal imaging is followed without other treatment. As the mesenteric mass usually resolves independently.

• Corticosteroids like Prednisolone are suggested to decrease inflammation. However, it causes many side effects in long-term use and is mainly discontinued.

• Anti-inflammatory drugs like Colchicine, Cyclophosphamide, and Infliximab are also provided to improve the symptoms by decreasing inflammation.

• Thalidomide is an effective drug that alleviates the symptoms and decreases the raised ESR and CRP levels.

• Naltrexone, in low doses, regulates the immune system and raises the levels of endorphins (substances that reduce pain).

• Hormone therapy with Tamoxifen is used in patients with increased scarring of mesenteric tissues. It is sometimes combined with corticosteroids for treatment. But, the drug leads to side effects like blood clot formation and secondary neoplasm.

• Surgery is planned in case of any small intestine obstruction, but it has not been opted if mesenteric mass alone is present.

Conclusion:

Mesenteric panniculitis is a rare disorder and causes mild to severe symptoms. However, the disease shows a good prognosis for treatment. Various imaging techniques have evolved to help diagnose and help patients. A physician's knowledge plays a crucial role in diagnosing and managing diseases.