Mesenteric panniculitis: an update

Abstract

In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as ‘retractile mesenteritis.’ It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.

Keywords:

• inflammation
• mesenteric
• mesentery
• panniculitis
• sigmoid
• small bowel

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Mesenteric panniculitis is a fibroinflammatory condition of unknown etiology.

• The patients usually have recurrent complaints of the same rapidly reversible and variable clinical presentations.

• Computed tomography is optimal for accurate, noninvasive diagnosis of mesenteric panniculitis and follow-up of sclerosing mesenteritis and of any complications. The presence of some radiological findings such as lymph node size of more than 12 mm and the absence of the fat ring sign should raise the concern of subsequent malignancy in patients with mesenteric panniculitis.

• Some authors consider mesenteric panniculitis as a single disease entity with two pathological subgroups: mesenteric panniculitis (common subgroup), where inflammation and fat necrosis predominate, and retractile mesenteritis (rare subgroup), where fibrosis and retraction predominate.

• In mesenteric panniculitis, the fibroinflammatory condition may infiltrate other organs such as the urinary bladder and the pancreas presenting as palpable mass, raising the concern for malignancy.