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Drews MA, Baumgarten A, Zensen S, Opitz M, Bos D, Zimmer L, Ugurel S, Haubold J, Schadendorf D, Livingstone E, Schaarschmidt BM. Adverse effects of systemic advanced melanoma therapies-do BRAF/MEK inhibitors increase the incidence of mesenteric panniculitis? Eur Radiol 2025:10.1007/s00330-025-11642-w. [PMID: 40310541 DOI: 10.1007/s00330-025-11642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 02/11/2025] [Accepted: 04/07/2025] [Indexed: 05/02/2025]
Abstract
OBJECTIVES BRAF/MEK inhibitors (BRAFi/MEKi) and PD-1 and CTLA-4 immune checkpoint inhibitors (ICI) have revolutionized malignant melanoma treatment and improved patients' clinical outcome significantly. However, these therapies are associated with substance class-specific side effects. Here, selected cases indicate a correlation between the incidence of mesenteric panniculitis (MP) and BRAFi/MEKi treatment. As MP can mimic or conceal underlying malignancy, the aim of the present study was to confirm a potential correlation with BRAFi/MEKi or ICI in a retrospective, observational analysis of melanoma patients. MATERIALS AND METHODS In a monocentric retrospective study, abdominal CTs of 490 melanoma patients receiving first-line treatment with ICI (nivolumab, ipilimumab, pembrolizumab, nivolumab/ipilimumab) or BRAFi/MEKi (dabrafenib/trametinib, vemurafenib/cobimetinib, encorafenib/binimetinib) in the adjuvant or advanced situation were evaluated for MP development comparing baseline imaging prior therapy start and follow-up imaging under therapy. MP was defined as an unilocular mesenteric mass characterized by small tissue nodules with increased density of the adjacent fat and a surrounding pseudo-capsule. RESULTS 384 melanoma patients with ICI (161 women, median age at therapy start: 62 years, IQR: 21 years) and 106 patients with BRAFi/MEKi first-line therapy (46 women, median age: 58 years, IQR: 18 years) were evaluated. MP incidence was significantly higher following BRAFi/MEKi treatment compared to ICI (7.5% vs. 2.9%, p = 0.04). No significance was detected comparing time until MP development from therapy start (174 days, IQR: 518 days [BRAFi/MEKi] vs. 207 days, IQR: 298 days [ICI], p > 0.05). CONCLUSION Our study demonstrates a significant increase in MP development following BRAFi/MEKi treatment compared to ICI in patients with melanoma. As this benign condition can mimic or even conceal malignancy, awareness of its appearance is important. KEY POINTS Question BRAF/MEK and immune checkpoint inhibitors have revolutionized melanoma treatment but are associated with various side effects, yet data regarding the development of mesenteric panniculitis are scarce. Findings BRAF/MEK inhibitor treatment is associated with a significantly higher rate of mesenteric panniculitis compared to immune checkpoint inhibitor treatment in advanced melanoma. Clinical relevance BRAF/MEK inhibitor-treated patients are at risk for development of mesenteric panniculitis. As this benign finding can mimic or conceal malignancy, awareness of it is important especially in these patients.
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Affiliation(s)
- Marcel Alexander Drews
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Alexander Baumgarten
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | | | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Worthington MT, Wolf JL, Crockett SD, Pardi DS. AGA Clinical Practice Update on Sclerosing Mesenteritis: Commentary. Clin Gastroenterol Hepatol 2025; 23:902-907.e1. [PMID: 40119869 DOI: 10.1016/j.cgh.2024.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 03/24/2025]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association Institute Clinical Practice Update is to review the available evidence for diagnosing and treating, as well as examine opportunities for future research in, sclerosing mesenteritis. METHODS This Clinical Practice Update expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important and recently published studies in this field, and it reflects the experiences of the authors who are gastroenterologists with expertise in this topic.
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Affiliation(s)
- Mark T Worthington
- Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, Virginia.
| | - Jacqueline L Wolf
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Seth D Crockett
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, Oregon
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Geyer-Roberts E, Grote J, Banuelos A. Mesenteric Panniculitis in a Renal Transplant Patient With Systemic Lupus Erythematosus. Cureus 2025; 17:e80340. [PMID: 40206886 PMCID: PMC11980525 DOI: 10.7759/cureus.80340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 03/04/2025] [Indexed: 04/11/2025] Open
Abstract
Mesenteric panniculitis (MP) is a disease of unknown etiology, causing fibrosis of the small bowel mesentery. MP is typically diagnosed incidentally with computed tomography imaging but is occasionally associated with surgery, trauma, and cancer. The prevalence of MP varies across the literature; however, it is agreed upon to be a rare diagnosis. This case describes a 34-year-old female with systemic lupus erythematosus (SLE) who presented with abdominal symptoms and was later found to have MP. We postulated that the patient's SLE flare and adjustment in immunosuppressive medications facilitated the development of MP. This case highlights the need for further research regarding the association of MP and autoimmune conditions such as SLE.
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Affiliation(s)
- Elizabeth Geyer-Roberts
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Julia Grote
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Souphia R, Sawssen BM, Wael F, Mannai MH, Bechir KM. Mesenteric panniculitis: A case report. Int J Surg Case Rep 2025; 127:111000. [PMID: 39904024 PMCID: PMC11840212 DOI: 10.1016/j.ijscr.2025.111000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Revised: 01/29/2025] [Accepted: 01/30/2025] [Indexed: 02/06/2025] Open
Abstract
INTRODUCTION AND IMPORTANCE Mesenteric panniculitis is a rare, benign condition characterized by chronic inflammation and fibrosis of mesenteric adipose tissue (Hussein and Abdelwahed, 2015; Gögebakan et al., 2018 [1, 2]). While its etiology remains unclear in many cases, it has been associated with various conditions including abdominal surgery, trauma, and inflammatory diseases (Buragina et al., 2019 [3]). Understanding its presentation and management is crucial for proper patient care. CASE PRESENTATION We present a case of mesenteric panniculitis in a 49-year-old woman who presented with significant weight loss. The diagnosis was confirmed through imaging studies and tissue biopsy, with successful symptomatic management through conservative treatment. CLINICAL DISCUSSION The condition typically presents with nonspecific symptoms including abdominal pain, nausea, and weight loss, though it may be discovered incidentally. Diagnosis relies on a combination of imaging findings, particularly the characteristic "misty mesentery" appearance on CT scan, and when indicated, histological confirmation. CONCLUSION Early recognition and appropriate management of mesenteric panniculitis are essential for optimal outcomes. While usually benign, the condition requires thorough evaluation to exclude underlying malignancy and careful monitoring to prevent complications.
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Affiliation(s)
- Rabti Souphia
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
| | - Ben Marzouk Sawssen
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Farjaoui Wael
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Mohamed Hedi Mannai
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Khalifa Mohamed Bechir
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
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Schweistein H, Weintraub Y, Hornik-Lurie T, Haskiya H, Rave A, Glusman Bendersky A, Issa N, Naftali T, Gingold-Belfer R. Upper and Lower Endoscopic Findings in Mesenteric Panniculitis Patients: A Case-Control Study. J Clin Med 2024; 13:6709. [PMID: 39597853 PMCID: PMC11595034 DOI: 10.3390/jcm13226709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 10/24/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024] Open
Abstract
Background: The natural history and prognosis of mesenteric panniculitis (MP) are not well-described. Despite referral for colonoscopy being common for this indication, colonoscopy findings in MP patients have not been reported. Therefore, we aimed to describe upper and lower gastrointestinal (GI) endoscopy findings in patients with mesenteric panniculitis, compared to matched controls, to investigate their clinical outcomes including incidence of malignancy and mortality. Methods: Retrospective case-control study was conducted, and included patients who were diagnosed with mesenteric panniculitis according to Coulier radiologic criteria on abdominal computerized tomography between 1/2005 and 12/2019, and followed to 12/2021. The case group was compared to a matched control group without MP on abdominal CT. Clinical data and the upper and lower endoscopies' reports were reviewed in both groups. We excluded patients who, beyond diagnosis of MP, were also diagnosed with current malignancy, significant intra-abdominal morbidity or inflammatory bowel disease. Results: The initial set of 376 patients with MP, after exclusion, included 187 patients. A total of 56.1% were male, with a mean age 60 ± 15 years. Of them, 74 (39%) patients underwent follow-up CT scans, which demonstrated, in 66 (89.2%) patients, a stable MP without any aggravation. Colonoscopy was performed in 89 MP patients, and 98/187 controls. No significant difference in the colonoscopies' findings was found between the two groups. Gastroscopy was performed in 84 MP and 79 controls. No case of gastric cancer was found. No statistically significant difference was found in the rate of gastroscopy findings. By the end of the follow-up period, malignancy was diagnosed in four patients of the MP group. None were colon cancer. The mortality rate in the MP group was 3.2%, without a significant difference compared to the controls. None were MP related. Conclusions: MP identified on abdominal CT is not associated with pathologic endoscopy findings or future diagnosis of colon cancer, and also has no impact on mortality rate. Since repeating abdominal CT did not reveal any disease progression, the necessity of follow-up imaging for MP should be carefully reconsidered.
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Affiliation(s)
- Hagai Schweistein
- Gastroenterology Division Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Weintraub
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | | | - Hassan Haskiya
- Department of Diagnostic Imaging, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Adi Rave
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ahinoam Glusman Bendersky
- Gastroenterology Division Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nidal Issa
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Surgery Rabin Medical Center—Hasharon Hospital, Petach Tikva 49372, Israel
| | - Timna Naftali
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
- Division of Gastroenterology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Rachel Gingold-Belfer
- Gastroenterology Division Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
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Flor N, Ferretti F, Pellegrinelli A, Tubazio I, Colombo F. Sclerosing mesenteritis: a rare disease involving the adipose tissue of the bowel mesentery. Intern Emerg Med 2024; 19:1493-1495. [PMID: 38194001 DOI: 10.1007/s11739-023-03510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Nicola Flor
- Unità Operativa Di Radiologia, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Francesca Ferretti
- Unità Operativa Di Gastroenterologia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Alessandro Pellegrinelli
- Unità Operativa Di Anatomia Patologica, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Igor Tubazio
- Unità Operativa Di Chirurgia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - Francesco Colombo
- Unità Operativa Di Chirurgia, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
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Wang H, Zhao Z, Cao Q, Ning J. A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China. BMC Gastroenterol 2024; 24:48. [PMID: 38267839 PMCID: PMC10809466 DOI: 10.1186/s12876-024-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Mesenteric panniculitis (MP) represents the uncommon, benign and chronic inflammatory disorder affecting the mesenteric adipose tissues. Its etiology, diagnosis and treatment remain unnoticed. Our report focused on shedding more lights on this condition. PATIENTS AND METHODS Seventeen MP patients were identified by searching the electronic medical record system in the Zhengzhou Ninth People's Hospital using the search terms "Mesenteric panniculitis" from October 2015 to March 2023. All cases were diagnosed with MP through computed tomography (CT). Their clinical features and treatments were analyzed. RESULTS There were altogether 17 cases enrolled for this analysis. The male to female ratio was 8:9, and the median age at diagnosis was 64 (range: 37-96) years. There were 15 patients (88.2%) showing abdominal pain to varying degrees. The proportions of symptoms of nausea, vomiting and fever were 23.5%, 23.5% and 41.2%, respectively. Neoplastic disease was present in 3 patients (17.6%). Meanwhile, 9 patients (52.9%) had gallstones, 3 (17.6%) had cholecystitis and 1 (5.9%) had gallbladder polyps. Six patients (35.3%) received antibiotics treatment only and 1 (5.9%) received oral antibiotics and prednisone. One patient (5.9%) received antibiotics followed by prednisone treatment, because the symptoms were significantly relieved after antibiotic treatment, while the disease recurred soon after, and the symptoms improved again after prednisone treatment. The abdominal pain in 9 patients (52.9%) was relieved spontaneously. Two patients (11.8%) died, including one due to respiratory failure caused by pneumonia and the other one because of pancreatic cancer with lung and liver metastases. CONCLUSION MP is a poorly understood chronic inflammatory disease. Patients often have abdominal pain as the main symptom, accompanied by comorbidities in the gallbladder, and the prognosis is usually good after correct diagnosis and treatment, Therefore, the present report aims to promote the awareness among clinicians of patients with non-classic abdominal symptoms, so as to avoid misdiagnosis or missed diagnosis.
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Affiliation(s)
- Hongyan Wang
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Zhenyu Zhao
- Radiology, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Qiucai Cao
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Jing Ning
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China.
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Cecilio Azar, Ibrahim MA, El Kouzi Z, El Mokahal A, Omran N, Muallem N, Sharara AI. Mesenteric Panniculitis. Inflamm Intest Dis 2024; 9:157-164. [PMID: 39015257 PMCID: PMC11250460 DOI: 10.1159/000539432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/16/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Mesenteric panniculitis (MP) is an uncommon non-neoplastic idiopathic inflammation of adipose tissue, mainly affecting the mesentery of the small intestine, with its etiology remaining largely speculative. The difference in prevalence of MP among females and males varies across multiple studies. In most cases, MP is asymptomatic; however, patients can present with nonspecific abdominal symptoms or can mimic underlying gastrointestinal and abdominal diseases. The diagnosis is suggested by computed tomography and is usually confirmed by surgical biopsies if necessary. Treatment is generally supportive and based on a few selected drugs, namely, nonsteroidal anti-inflammatory drugs or corticosteroids. Surgery is reserved when the diagnosis is unclear, when malignancy is suspected or in the case of severe presentation such as mass effect, bowel obstruction, or ischemic changes. SUMMARY MP is a rare inflammatory condition of the mesentery often asymptomatic but can cause nonspecific abdominal symptoms. Diagnosis relies on computed tomography imaging, with treatment mainly supportive, utilizing medications like nonsteroidal anti-inflammatory drugs or corticosteroids, while surgery is reserved for severe cases or diagnostic uncertainty. KEY MESSAGES MP causes abdominal pain, and it is mainly diagnosed with CT scan.
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Affiliation(s)
- Cecilio Azar
- Division of Gastroenterology, Clemenceau Medical Center, Dubai, United Arab Emirates
| | - Mohamad Ali Ibrahim
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zakaria El Kouzi
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali El Mokahal
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Omran
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim Muallem
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I. Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
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Wang J, Li B. CT findings of idiopathic mesenteric panniculitis and analysis of related factors. Eur J Radiol 2023; 167:111071. [PMID: 37666075 DOI: 10.1016/j.ejrad.2023.111071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To analyze the computed tomography (CT) findings of idiopathic mesenteric panniculitis and the factors related to its characteristics and to improve the understanding of the disease. METHODS The imaging findings of 121 patients with mesenteric panniculitis were retrospectively analyzed, along with related factors such as age, sex, and abdominal visceral fat area. RESULTS Among the 121 patients, two had midgut malrotation, and the lesions were located outside the mesentery on the right side of the abdominal cavity, while the lesions in the other patients were located around the mesentery on the left side of the abdominal cavity, presenting as patchy or patchy fuzzy high-density masses. Annulus fibrosus and/or fatty ring signs were also observed in some patients. Scattered soft tissue nodules were observed around the mesentery in 119 patients. Eight patients had intestinal tract traction and retraction, and one patient had secondary intestinal obstruction. Nearly half of the patients had mesenteric vascular changes, and three had mesenteric vascular thrombosis. Among the 121 patients, there were 89 males and 32 females, aged 22-83, with an average age of 52.14 ± 13.53 years. The distribution range of abdominal visceral fat area (VFA) in 121 patients was 79.85-331.65 cm2. CONCLUSION Mesenteric panniculitis has certain characteristic imaging findings that can be accompanied by often ignored changes in the mesenteric blood vessels and intestinal tubes. Intestinal obstruction and mesenteric vascular thrombosis are rare complications, and their primary causes are often overlooked. Mesenteric panniculitis was correlated with sex, age, and VFA.
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Affiliation(s)
- Jieqiong Wang
- Radiology Department, Taikang Xianlin Drum Tower Hospital, No. 188 Lingshan North Road, Qixia District, Nanjing City, Jiangsu Province, China
| | - Baohong Li
- Radiology Department, Taikang Xianlin Drum Tower Hospital, No. 188 Lingshan North Road, Qixia District, Nanjing City, Jiangsu Province, China.
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Gavriilidis P, de' Angelis N. Conservative Management of Mesenteric Panniculitis in a Remote Island. Case Rep Surg 2023; 2023:3335738. [PMID: 37124971 PMCID: PMC10147526 DOI: 10.1155/2023/3335738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Mesenteric panniculitis (MP) includes a spectrum of nonspecific fibroinflammatory disorders of unknown aetiology that affects mainly the root of the mesentery. Case Report. A 68-year-old man is incidentally diagnosed with MP during follow-up investigation for a fusiform coeliac artery aneurysm. Four years since the diagnosis, he is completely asymptomatic. After discussing with him and presenting the current evidence, he decided not to proceed with biopsy because the finding was incidental and he is asymptomatic. Moreover, tumour markers were within the normal range. He has been scheduled for annual follow-ups with computerized tomography (CT) scans and tumour markers. CONCLUSIONS MP is a rare chronic fibroinflammatory disease with contradictory evidence regarding its definition and management. Watchful follow-ups with CT scan and tumour markers are recommended for asymptomatic patients.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgery, Saint Helena General Hospital, Jamestown, STHL 1ZZ, Saint Helena, UK
| | - Nicola de' Angelis
- Colorectal and Digestive Surgery Unit at Hospital Beaujon, 100 Bd du Général Leclerc, Clichy 92110, France
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11
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Sulbaran M, Chen FK, Farraye FA, Hashash JG. A Clinical Review of Mesenteric Panniculitis. Gastroenterol Hepatol (N Y) 2023; 19:211-218. [PMID: 37705847 PMCID: PMC10496345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Mesenteric panniculitis (MP) is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery. MP is commonly detected incidentally on cross-sectional imaging of the abdomen and can be asymptomatic in up to nearly half of patients. The most frequent clinical symptom reported is abdominal pain, followed by bloating/distention, diarrhea, constipation, vomiting, anorexia, weight loss, fever, malaise, and nausea. On computed tomography, MP is seen as a mass-like area of increased fat attenuation within the small bowel mesentery, usually located in the left upper quadrant of the abdomen. This mass-like area envelops mesenteric vessels and displaces adjacent bowel segments. Lymph nodes are frequently seen within the area of mesenteric abnormality. One of the most common differential diagnoses of MP is lymphoma, and positron emission tomography/computed tomography may be performed if there is suspicion of a concurrent underlying malignancy. Because of the benign nature of MP, treatment decisions should be guided by severity of symptoms and presence of complications. First-line medical treatment is prednisone and tamoxifen. Surgery is reserved for cases of recurrent bowel obstruction. This article provides a review of MP, including its epidemiology, pathophysiology, clinical presentation, imaging findings, and treatment.
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Affiliation(s)
- Marianny Sulbaran
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Frank K. Chen
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Francis A. Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Jana G. Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Abstract
Mesenteric panniculitis is encountered frequently during abdominopelvic CT scanning, often as an incidental finding. The observation is problematic because an association with malignancy has been raised in the literature. This review will describe the CT appearances and examine the available evidence regarding the significance of this finding.Ultimately, the literature remains unclear regarding how these patients should be managed, if at all.
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Affiliation(s)
- Vivienne N Eze
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Steve Halligan
- University College London Centre for Medical Imaging, London, United Kingdom
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13
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Yamamoto K, Honda H, Ogawa H, Otsuka F. Key signs indicating mesenteric panniculitis. Clin Case Rep 2022; 10:e6654. [PMID: 36514474 PMCID: PMC9731291 DOI: 10.1002/ccr3.6654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
Since patients with mesenteric panniculitis (MP) present non-specific symptoms, diagnosing MP is challenging. We describe a 45-year-old man who developed MP with radiologic findings of a "fat ring sign" and a "tumoral pseudocapsule sign." These signs shown in the present case are crucial for a precise diagnosis of MP.
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Affiliation(s)
- Koichiro Yamamoto
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroyuki Honda
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroko Ogawa
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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14
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Mesenteric panniculitis is associated with cardiovascular risk-factors: A case-control study. Dig Liver Dis 2022; 54:1657-1661. [PMID: 35853820 DOI: 10.1016/j.dld.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study evaluated the prevalence of cardiovascular risk-factors in patients with mesenteric panniculitis. AIMS To determine whether cardiovascular risk-factors and mesenteric panniculitis are associated. METHODS Retrospective, matched case-control study of patients referred to Meir Medical Center, Israel, 2014-2019, who underwent computerized tomography scan, were diagnosed mesenteric panniculitis by radiologic criteria. They were compared to two, matched case-control groups: hospitalized patients without mesenteric panniculitis and the general population based on Israeli Ministry of Health surveys. Patients with active malignancy, IBD or significant intra-abdominal morbidity were excluded. RESULTS Of 376 patients with mesenteric panniculitis diagnosed by computerized tomography, 187 were included. Compared to hospital patients, they had higher incidence of dyslipidemia (77.5%/56.7%), hypertension (52.4%/40.6%), obesity (body mass index>30) (60.4%/30.5%) and nonalcoholic fatty liver disease (42.2%/16.6%). Similar differences were observed compared to the general population. In multivariable logistic regression, dyslipidemia, obesity, and nonalcoholic fatty liver disease were independent predictors for mesenteric panniculitis. CONCLUSIONS Patients with mesenteric panniculitis have more cardiovascular risk-factors compared to a case-control group and to the general population. This suggests that mesenteric panniculitis is clinically significant and may be part of the metabolic morbidity burden. This association should be further explored.
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15
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Sharawi S, Graffeo V, Goebel LJ. Sclerosing Mesenteritis: A Rare Cause of Abdominal Pain. Cureus 2022; 14:e28573. [PMID: 36185930 PMCID: PMC9520956 DOI: 10.7759/cureus.28573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea. SM occurs predominantly in Caucasian men, during the fifth to seventh decades of life. We present a 69-year-old woman with SM whose symptoms were thought to be from irritable bowel syndrome. A 69-year-old female with a history of fibromyalgia presented with recurrent bouts of abdominal pain across her mid-abdomen lasting 30 minutes to an hour associated with nausea, alternating constipation and diarrhea with occasional mucus, and bloating. She used bismuth subsalicylate and ondansetron with temporary relief. Upper endoscopy and colonoscopy were unrevealing. Initially, she was felt to have irritable bowel. Later she presented with nausea and right upper quadrant pain and underwent cholecystectomy. When her pain recurred, the patient had a CT abdomen and pelvis which showed multiple sub-centimeter mesenteric lymph nodes with surrounding haziness and stranding in the root of the mesentery consistent with SM. The patient had a pannus biopsy showing fat necrosis that confirmed the diagnosis. She continued to have waxing and waning symptoms over several years and in the interim was diagnosed with melanoma limited to the skin. The patient had a particularly severe episode of abdominal pain prompting a repeat CT scan with a subsequent biopsy of an enlarged left para-aortic lymph node that revealed lymphoma. Our patient’s diagnosis of SM was delayed as her symptoms were mistaken for irritable bowel syndrome. Worsening symptoms should alert clinicians to an alternate diagnosis such as SM. There are characteristic radiographic findings on CT scans and biopsy of the lesions. SM’s association with neoplastic diseases such as lymphoma, melanoma, colorectal, and prostate cancer is controversial, however, practitioners should be aware of this possibility and consider biopsy for any suspicious lesions.
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16
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CT features associated with underlying malignancy in patients with diagnosed mesenteric panniculitis: Mesenteric panniculitis: CT features associated with underlying malignancy. Diagn Interv Imaging 2022; 103:394-400. [PMID: 35843840 DOI: 10.1016/j.diii.2022.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to identify abdominal computed tomography (CT) features associated with underlying malignancy in patients with mesenteric panniculitis (MP). MATERIALS AND METHODS This single-institution retrospective longitudinal cohort study included patients with MP and a minimum 1-year abdominopelvic CT follow-up or 2-year clinical follow-up after initial abdominopelvic CT examination. Two radiologists, blinded to patients' medical records, conjointly reviewed CT-based features of MP. Electronic medical records were reviewed for newly diagnosed malignancies with the following specific details: type (lymphoproliferative disease or solid malignancy), location (possible mesenteric drainage or distant), stage, time to diagnosis. An expert panel of three radiologists and one hemato-oncologist, who were blinded to the initial CT-based MP features, assessed the probability of association between MP and malignancy based on the malignancy characteristics. RESULTS From 2006 to 2016, 444 patients with MP were included. There were 272 men and 172 women, with a median age of 64 years (age range: 25-89); the median overall follow-up was 36 months (IQR: 22, 60; range: 12-170). A total of 34 (8%) patients had a diagnosis of a new malignancy; 5 (1%) were considered possibly related to the MP, all being low-grade B-cell non-Hodgkin lymphomas. CT features associated with the presence of an underlying malignancy were the presence of an MP soft-tissue nodule with a short axis >10 mm (P < 0.0001) or lymphadenopathy in another abdominopelvic region (P < 0.0001). Associating these two features resulted in high diagnostic performance (sensitivity 100%; [95% CI: 57-100]; specificity 99% [95% CI: 98-100]). All related malignancies were identified. CONCLUSION Further workup to rule out an underlying malignancy is only necessary in the presence of an MP soft-tissue nodule >10 mm or associated abdominopelvic lymphadenopathy.
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17
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Whittle C, Schiappacasse G, Maldonado I, Villacres F, Hebel E, González F. Recognizing the Ultrasound Patterns of Mesenteric Panniculitis. Ultrasound Q 2022; 38:185-190. [PMID: 33394995 DOI: 10.1097/ruq.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Mesenteric panniculitis (MP) is a rare, benign, and nonspecific chronic fibrosing inflammation of the mesenteric adipose tissue. Abdominal pain is the most frequent presentation.The objective was to recognize ultrasound (US) features in MP. A retrospective 9-year review of computed tomography- (CT) or US-diagnosed cases of MP recorded in the radiology department was performed. The inclusion criteria included an US recorded in PACS imaging data base within 10 days before CT, to compare and evaluate the correlation of MP diagnosis.The prevalence of MP on CT was 2.8%. The 120 selected patients had an abdominal US 10 days before CT. Male-to-female ratio was 4:1. Fifty-three percent of MP was suggested by US. The US finding was increased volume with fatty mass in the mesentery root (98%). The fatty mesenteric mass had oval shape or convex anterior border in 94%, central abdominal location in 91%, and focal mesenteric increased echogenicity in 95%. Lateral bowel loop displacement was observed in 59%. Detection of lymph nodes was less frequent (55%).In conclusion, MP is an entity to be considered in the differential diagnosis of abdominal pain. Knowledge and recognition of the US findings of MP and central abdominal compression may improve detection during the abdominal US examination.
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Affiliation(s)
| | | | | | - Fabian Villacres
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Esteban Hebel
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Santiago, Chile
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18
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Hussain I, Ishrat S, Aravamudan VM, Khan SR, Mohan BP, Lohan R, Abid MB, Ang TL. Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29143. [PMID: 35512070 PMCID: PMC9276205 DOI: 10.1097/md.0000000000029143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP. METHODS MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated. RESULTS Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group. CONCLUSION This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.
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Affiliation(s)
- Ikram Hussain
- Division of Gastroenterology, Department of Medicine, Woodlands Health Campus, Singapore
| | | | | | - Shahab R. Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Babu P. Mohan
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, UT
| | - Rahul Lohan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Muhammad Bilal Abid
- Divisions of Infectious Diseases & Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
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19
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Zhao L, Xie D. Mesenteric Panniculitis Can Be Diagnosed by Examination and Cured by Comprehensive Therapy. Gastroenterol Nurs 2021; 44:278-283. [PMID: 34149040 DOI: 10.1097/sga.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Mesenteric panniculitis is a rare, slowly progressive, benign, and chronic fibrous inflammatory disease that affects the adipose tissue of the mesentery. In the present study, we aim to investigate its clinical presentations, computed tomography/sonography scan features, effectiveness of the treatment, and overall prognosis. We investigated various presentations, etiologies, diagnostic approaches, potential treatment modalities, and overall prognosis of mesenteric panniculitis. We present one case of mesenteric panniculitis with abdominal pain, which underwent steroid treatment regimens subsequently and gained weight moderately. An abdomen and pelvis cavity computed tomography scan showed misty mesentery, an ill-defined increase in the density of the peritoneal fat at the base of the mesentery with few small associated lymph nodes. The appearance is that of a panniculitis. His symptoms gradually decreased in intensity and disappeared totally within 1 month after oral prednisone 40 mg per day and moderate gain weight. Computed tomography scan features of the disease have recently been delineated clearly. Standard treatment strategy does not exist, and the current ways mainly consist of immunosuppressor or anti-inflammation agents. Overall prognosis is usually good and recurrence seems to be rare.
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Affiliation(s)
- Li Zhao
- Li Zhao, MD, is Doctor-in-charge, Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
- Dajiang Xie, MD, is Doctor-in-charge, Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Dajiang Xie
- Li Zhao, MD, is Doctor-in-charge, Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
- Dajiang Xie, MD, is Doctor-in-charge, Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
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20
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Mrozikiewicz-Rakowska B, Zygmunciak M, Głażewski T, Mieczkowski M, Podgórska J, Rowiński O, Czupryniak L. The Use of Glucocorticoids for Better Control of Diabetes Mellitus: The Paradox of Sclerosing Mesenteritis (The Rare Could Become Common). AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930453. [PMID: 34054123 PMCID: PMC8174387 DOI: 10.12659/ajcr.930453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patient: Male, 57-year-old Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain Medication: Prednisone Clinical Procedure: CT scan • MRI Specialty: Endocrinology and Metabolic
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Affiliation(s)
| | - Mateusz Zygmunciak
- Department of Diabetology and Internal Diseases, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Tomasz Głażewski
- Department of Diabetology and Internal Diseases, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Mateusz Mieczkowski
- Department of Diabetology and Internal Diseases, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Joanna Podgórska
- Second Department of Clinical Radiology, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical Univeristy of Warsaw, Warsaw, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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21
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Gunes SO, Akturk Y, Guldogan ES, Yilmaz KB, Ergun O, Hekimoglu B. Association between mesenteric panniculitis and non-neoplastic disorders. Clin Imaging 2021; 79:219-224. [PMID: 34119913 DOI: 10.1016/j.clinimag.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relationship between MP and coexisting non-neoplastic disorders. METHODS Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann-Whitney U, χ2, or Fisher's test. RESULTS 976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064-0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012-0.036). CONCLUSION MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.
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Affiliation(s)
- Serra Ozbal Gunes
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey.
| | - Yeliz Akturk
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Esra Soyer Guldogan
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Kerim Bora Yilmaz
- Department of General Surgery, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Onur Ergun
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
| | - Baki Hekimoglu
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Dıskapı, 06130 Ankara, Turkey
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22
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A rare cause of abdominal pain: Mesenteric panniculitis. North Clin Istanb 2021; 8:186. [PMID: 33851084 PMCID: PMC8039101 DOI: 10.14744/nci.2020.84704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/05/2020] [Indexed: 11/20/2022] Open
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Asghar MS, Tauseef A, Naman D, Zafar M, Rasheed U, Khan N, Alvi H, Shaikh N. Mesenteric Panniculitis in a Patient with Homozygous Factor V Leiden Gene Mutation: A Case and Literature to Review. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 30-year-old Asian male with a significant history of deep vein thrombosis and family history positive for pulmonary embolism presented with complaints of fever, nonradiating epigastric pain, and a sense of abdominal fullness. After the initial workup, ultrasonography of the whole abdomen was carried out which showed thrombus formation in the portal vein. A CT scan of the abdomen was performed, which showed findings suggestive of mesenteric panniculitis. Keeping the significant family history and imaging findings in mind, the clotting and thrombin profiles were analysed and came back positive for the factor V Leiden gene (homozygous). A CT angiogram was performed to demonstrate extensive thrombosis throughout the abdominal vasculature with cavernous transformation. It is asserted that the chronic thrombosis on a background of factor V mutation led towards chronic inflammation of the mesentery. To the authors’ knowledge it is the first reported case of mesenteric panniculitis in a patient with factor V homozygous gene mutation.
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Affiliation(s)
| | - Abubakar Tauseef
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Durre Naman
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Maryam Zafar
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Uzma Rasheed
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Narmin Khan
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Haris Alvi
- Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimra Shaikh
- Liaquat National Hospital and Medical College, Karachi, Pakistan
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25
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Dahiya DS, Kichloo A, Singh J, Albosta MS, Wani F, Aljadah M, Haq KF. Acute Recurrent Exacerbations of Mesenteric Panniculitis With Immunosuppressive Therapy: A Case Report and a Brief Review. J Investig Med High Impact Case Rep 2020; 8:2324709620969581. [PMID: 33138661 PMCID: PMC7649945 DOI: 10.1177/2324709620969581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mesenteric panniculitis (MP) is a rare, benign, and idiopathic disorder characterized by chronic inflammation of the mesenteric adipose tissue of the small intestine. The exact etiology of MP is unknown and its associations with underlying malignancies continues to be poorly understood. In this case report, we describe a rare case of acute exacerbations of MP in a middle-age female with a known past medical history of non-Hodgkin’s lymphoma in remission and small bowel resection for a localized carcinoid tumor. The patient was diagnosed with MP 4 years ago and started on tamoxifen therapy with adequate control of her symptoms. Last year, she reported to the emergency department with multiple episodes of sudden-onset, severe, and localized right upper quadrant abdominal pain and nausea without vomiting. She was diagnosed with an acute exacerbation of MP and a decision was made to add 60 mg prednisone daily in addition to her tamoxifen regimen. She remained symptomatically stable for the next 6 months after the start of dual therapy with tamoxifen and prednisone. However, for the past 6 months, the patient reported to the emergency department on an average of 2 times/month with the same recurrent symptoms despite high compliance with tamoxifen and prednisone therapy. She was admitted for her pain management and her dose of prednisone was increased and she was subsequently discharged home with improvement of her symptoms. Her tamoxifen was switched to mycophenolate on her follow-up visit with gastrointestinal clinic, and her disease has remained stable for the past 2 months. Our case report discusses in-depth the literature on MP and its management. We also detail the steps in management of a rare case of recurrent acute exacerbations of MP despite the patient being on immunosuppressive therapy.
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Affiliation(s)
| | | | | | | | - Farah Wani
- Central Michigan University, Saginaw, MI, USA
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26
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Buragina G, Magenta Biasina A, Carrafiello G. Clinical and radiological features of mesenteric panniculitis: a critical overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:411-422. [PMID: 31910164 PMCID: PMC7233778 DOI: 10.23750/abm.v90i4.7696] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
The mesenteric panniculitis is a rare form of inflammation that mainly involves the mesenteric adipose tissue. The etiology remains unknown and the disease has been associated with various conditions such as cancer, abdominal trauma, previous surgery, autoimmune diseases and obesity. Mesenteric panniculitis can be divided into two main groups: the mesenteric panniculitis with only the inflammation and degeneration of the mesenteric fat, and the retractile panniculitis, mainly fibrotic, with retraction of the surrounding structures. From a radiological point of view, there are two main signs: the fat ring sign, which is the presence of normal fat around vessels and lymph nodes, and the pseudocapsula around the lesion. In this paper, we present the imaging and clinical features of mesenteric panniculits with particular reference to the differential diagnosis and the possible etiological associations. (www.actabiomedica.it)
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Meyyur Aravamudan V, Khan SR, Natarajan SK, Hussain I. The Complex Relationship between Mesenteric Panniculitis and Malignancy - A Holistic Approach is Still Needed to Understand the Diagnostic Uncertainties. Cureus 2019; 11:e5569. [PMID: 31695988 PMCID: PMC6820662 DOI: 10.7759/cureus.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Mesenteric panniculitis is an idiopathic, localized inflammation involving the adipose tissue of the small bowel mesentery. The association of mesenteric panniculitis with malignancy, predominantly lymphomas, has been widely reported in the medical literature. In this review article, we will discuss the clinical guidelines in the diagnosis and management of mesenteric panniculitis and the clinical association between mesenteric panniculitis and malignancies.
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Affiliation(s)
| | - Shahab R Khan
- Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, USA
| | | | - Ikram Hussain
- Internal Medicine: Gastroenterology, Woodlands Health Campus, Singapore, SGP
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28
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Patel A, Alkawaleet Y, Young M, Reddy C. Mesenteric Panniculitis: An Unusual Presentation of Abdominal Pain. Cureus 2019; 11:e5100. [PMID: 31428545 PMCID: PMC6693797 DOI: 10.7759/cureus.5100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sclerosing mesenteritis is a rare autoimmune disease that eventually evolves into fibrotic changes that usually affect the adipose tissue around the mesenteric vessels. It can present through a myriad of gastroenterological as well as constitutional symptoms, including but not limited to abdominal pain, diarrhea, fever, nausea, or vomiting. Although the exact etiology of the disease is yet to be determined, there are several predisposing factors, the most common of which is a previous history of abdominal trauma and/or surgery. Several case series have reported the association of sclerosing mesenteritis with prior abdominal surgery ranging from as low as 24% to as high as 53%.
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Affiliation(s)
- Ankit Patel
- Miscellaneous, Quillen College of Medicine, East Tennessee State University, Johnson CIty, USA
| | - Yazan Alkawaleet
- Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Mark Young
- Gastroenterology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Chakradhar Reddy
- Gastroenterology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
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Abstract
Sclerosing mesenteritis is a rare non-neoplastic disorder characterized by fat necrosis, chronic inflammation, and fibrosis typically of the small bowel mesentery. Our understanding of this disorder is limited by its rarity as well as inconsistent terminology used across the literature. While prior abdominal surgery or trauma, autoimmunity, infection, ischemia, and malignancy have been suggested to be involved in the pathogenesis of the disorder, it remains poorly understood. The clinical course of sclerosing mesenteritis is generally benign with a large proportion of patients diagnosed incidentally on imaging obtained for other indications. In a subset of patients, symptoms may arise from a mass effect on the bowel, lymphatics, or vasculature resulting in bowel obstruction, chylous ascites, or mesenteric ischemia. Symptomatic patients should be treated with a combination of corticosteroid and tamoxifen as first-line therapy based on retrospective case series and experience in other fibrosing disorders. Surgical intervention may be required in those with persistent obstruction despite conservative treatment, though complete resection of the mass is often not feasible given intimate involvement with the mesenteric vasculature. A careful use of terminology and communication between the radiologist, pathologist, and clinicians in the care of these patients will be essential to future efforts at understanding this disease.
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Rizos EC, Panagiotopoulou T, Liberopoulos E, Elisaf M, Tsili A, Argyropoulou MI, Tigas SK. IS MESENTERIC PANNICULITIS A SIGN FOR AUTOIMMUNE DIABETES IN ADULTS? AACE Clin Case Rep 2019; 5:e181-e183. [PMID: 31967029 PMCID: PMC6876940 DOI: 10.4158/accr-2018-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/01/2018] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Mesenteric panniculitis (MP) and sclerosing mesenteritis is an umbrella term used to describe a rare, chronic, and frequently benign fibrosing inflammatory disease that affects the adipose tissue of the mesentery. The diagnosis is usually based on imaging (computed tomography [CT] or magnetic resonance imaging) findings and is confirmed by biopsy. We report the unusual case of a patient with MP with typical CT findings and diabetes mellitus (DM). METHODS A 48-year-old male presented for symptomatic new onset DM. An abdominal CT scan revealed a well-defined mesenteric mass compatible with MP. The combination of insulin degludec and sitagliptin/metformin resulted in a decrease of HbA1c; however, this was followed by a subsequent gradual increase in HbA1c and positive glutamic acid decarboxylase auto-antibodies. RESULTS The patient developed auto-immune DM that was confirmed by the presence of auto-antibodies. CONCLUSION Panniculitis has been infrequently reported in patients with type 2 DM. This is the first report of a patient with MP correlated with auto-immune DM. The possible pathophysiologic mechanisms are discussed.
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Turcotte B, Toren P, Cloutier J. Images - Sclerosing mesenteritis presenting with unilateral hydro-ureteronephrosis. Can Urol Assoc J 2019; 13:E306-E308. [PMID: 30763232 DOI: 10.5489/cuaj.5689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bruno Turcotte
- Division of Urology, Department of Surgery, Université Laval, CHU de Québec, Hôpital St-François d'Assise, Quebec City, QC, Canada
| | - Paul Toren
- Division of Urology, Department of Surgery, Université Laval, CHU de Québec, Hôpital St-François d'Assise, Quebec City, QC, Canada
| | - Jonathan Cloutier
- Division of Urology, Department of Surgery, Université Laval, CHU de Québec, Hôpital St-François d'Assise, Quebec City, QC, Canada
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Al-Omari MH, Qararha K, Garaleh M, Smadi MM, Hani MB, Elheis M. Mesenteric panniculitis: comparison of computed tomography findings in patients with and without malignancy. Clin Exp Gastroenterol 2018; 12:1-8. [PMID: 30643446 PMCID: PMC6311320 DOI: 10.2147/ceg.s182513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose The aim was to compare computed tomography (CT) findings between patients with mesenteric panniculitis (MP) with and without known malignancy. Patients and methods We retrospectively analyzed 116 consecutive patients who were diagnosed with MP on the basis of CT findings and categorized them according to the absence (Group 1: 73 patients) or presence (Group 2: 43 patients) of malignancy. Patient age and sex, diameter, size, mass effect, location, and fat density of the MP mass, presence of a pseudocapsule and/or halo sign, and lymph node status were compared between the two groups. Results MP tends to be more common in males, and this trend shows statistical significance when combining the findings for both groups (P=0.041). Patients in Group 1 were significantly younger than those in Group 2 (54.29 vs 64.77 years, P=0.001). A well-defined fatty mass at the small bowel root was observed in all patients. The halo sign was present in most cases in both groups. A pseudocapsule was observed in 36 patients (49%) in Group 1 and 29 (67%) in Group 2 (P=0.045). The average craniocaudal diameter of the MP masses on the sagittal view was 11.14 and 12.5 cm in Groups 1 and 2, respectively (P=0.005). The MP fat density was less negative in patients with malignancy (–66 vs –76 HU, P=0.001). Lymph node status was similar in both groups. Conclusion Detailed CT features should be evaluated in patients with MP, as some of these features may indicate an associated malignancy, necessitating further investigation and close follow-up.
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Affiliation(s)
- Mamoon H Al-Omari
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Khaleel Qararha
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Mohammed Garaleh
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
| | - Mahmoud M Smadi
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Bani Hani
- Department of Surgery, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Mwaffaq Elheis
- Department of Radiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan,
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Green MS, Chhabra R, Goyal H. Sclerosing mesenteritis: a comprehensive clinical review. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:336. [PMID: 30306075 DOI: 10.21037/atm.2018.07.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sclerosing mesenteritis is a rare disease entity initially described in 1924 with a prevalence reported to be less than 1%. Sclerosing mesenteritis is a comprehensive term used to describe three almost similar clinical entities including mesenteric panniculitis, retractile mesenteritis, and mesenteric lipodystrophy which only differ by their histology. The etiology of sclerosing mesenteritis is uncertain, but the disease has been associated with trauma, autoimmune disease, surgery, and malignancy. The typical presenting symptom is the abdominal pain, but sclerosing mesenteritis has a broad constellation of presenting symptoms which often makes consideration of the diagnosis unlikely. Treatment for this little-understood disease ranges from surgical intervention for patients presenting with obstructive symptoms to immunosuppressive medical therapy for patients presenting with pain. The purpose of this article is to provide an overview of the literature relevant to the diagnosis, etiology, and management of this condition in hopes of making physicians aware of this unique condition.
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Affiliation(s)
- Michael S Green
- Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Rajiv Chhabra
- Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
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Mahafza WS, Manzalawi KA, Gharaibeh AA, Khayat OW, Shahait A, Juweid ME. Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history. Saudi Med J 2018; 38:1013-1018. [PMID: 28917065 PMCID: PMC5694634 DOI: 10.15537/smj.2017.10.20163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To assess the prevalence and associations of mesenteric panniculitis (MP) using multi-detector CT (MDCT). METHODS This retrospective study included 4758 consecutive patients who underwent abdomino-pelvic MDCT between January 2012 and December 2014 at Jordan University Hospital, Amman, Jordan. Radiological database was searched for MP diagnosis and patients with suspected MP were re-evaluated by an experienced radiologist to confirm the diagnosis. Data on all patients with confirmed MP diagnosis were subsequently collected and analyzed. RESULTS Computed tomography features of MP were identified in 90 patients (41 males, 49 females), a prevalence of 1.9%. Mesenteric panniculitis was identified in both asymptomatic and symptomatic patients. Malignancy was found in 28 MP patients (31%) and 44 of the MP patients (49%) had prior history of abdomino-pelvic surgery. Mesenteric panniculitis was significantly more frequently associated with prior abdomino-pelvic surgery (p=0.0001) and the likelihood of associated malignancy in patients with MP was 2.1-fold higher than in patients without MP (p=0.0013). Conclusion: Mesenteric panniculitis can be reliably diagnosed by MDCT due to its typical CT appearance. Its identification is important because of its significant association with malignancy and because it represents one of the differential diagnoses in patients with nonspecific symptoms referred for abdomino-pelvic CT.
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Affiliation(s)
- Waleed S Mahafza
- Diagnostic Radiology Department, The Jordan University Hospital, Amman, Jordan. E-mail.
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Kobayashi H, Notohara K, Otsuka T, Kobayashi Y, Ujita M, Yoshioka Y, Suzuki N, Aoyagi R, Ohashi R, Suzuki T. An Autopsy Case of Mesenteric Panniculitis with Massive Pleural Effusions. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:13-20. [PMID: 29298971 PMCID: PMC5763981 DOI: 10.12659/ajcr.905744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mesenteric panniculitis (MP) is an idiopathic chronic inflammatory condition of the mesentery. The main symptoms include abdominal pain, abdominal distention, weight loss, fever, nausea, and vomiting. The patients also present with chylous ascites in 14% of the cases and chylous pleural effusion (CPE) in very rare occasions. Despite the previous view of excellent prognosis of MP, two recent papers reported several fatal cases. However, there are still only a few autopsy case reports that describe the macroscopic and histological details of MP cases. CASE REPORT The patient was an 81-year-old Japanese woman. She complained of edema of her lower legs and face, general fatigue, and dyspnea. She was overweight and had type 2 diabetes (T2D). Computerized tomography (CT) demonstrated massive bilateral pleural effusions, with mild pericardial effusion and mild ascites. There was no pulmonary, cardiac or hepatic condition to explain the effusions. However, MP was suspected based on her CT. She gradually deteriorated into respiratory failure. The autopsy revealed CPEs (left 1,300 mL, right 1,400 mL) and MP in the mesentery of the small intestine. Neither neoplasia nor inflammatory conditions other than MP were detected. CONCLUSIONS In rare occasions, patients with MP present with CPE or chylothorax. We thought that a possible mechanism of the CPEs was a diaphragmatic defect. We suspected that being overweight and T2D had an etiological relationship with MP in our patient's case. Adipose tissue of the mesentery is the main focus of MP. We believed that MP would be the best umbrella term of the many synonyms.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kenji Notohara
- Department of Pathology, Kurashiki General Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Otsuka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuka Kobayashi
- Department of Oncology, Nagaoka Central Hospital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Naomasa Suzuki
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryuji Aoyagi
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Core Facility, Niigata University Faculty of Medicine, Niigata City, Niigata, Japan
| | - Toshimitsu Suzuki
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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Acu B, Güven ME, Kaptan MA, Öztunalı Ç, Gökçe E, Beyhan M, Kara T. Duplex Doppler Sonographic Assessment of the Superior Mesenteric Artery in Patients With Mesenteric Panniculitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:165-172. [PMID: 28731594 DOI: 10.1002/jum.14314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We aimed to determine how the hemodynamic parameters of the superior mesenteric artery are affected in mesenteric panniculitis. METHODS Twenty-one patients with a diagnosis of mesenteric panniculitis on computed tomography were evaluated with duplex Doppler sonography. The control group consisted 20 asymptomatic volunteers. The peak systolic velocity, end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), blood flow volume, and body mass index were measured in the group of patients with mesenteric panniculitis, and the findings were compared with those of the control group. RESULTS The mean blood flow volume and EDV were significantly higher in the patient group: The mean superior mesenteric artery blood flow volume ± SD was 917.86 ± 228.97 mL/min in the patient group versus 389.73 ± 92.72 mL/min in the control group (P < .001). The mean EDV was 31.56 ± 8.44 m/s in the patient group versus 19.27 ± 4.19 m/s in the control group (P < .001). The mean RI and PI were significantly lower in the patient group: The mean RI was 0.81 ± 0.04 in the patient group versus 0.85 ± 0.03 in the control group (P = .001). The mean PI was 2.69 ± 0.68 in the patient group versus 3.81 ± 1.13 in the control group (P = .001). the mean superior mesenteric artery diameter was 7.30 ± 0.67 mm in the patient group versus and 6.46 ± 0.66 mm in the control group (P < .001). The mean BMI was 27.95 ± 3.80 kg/m2 in the patient group versus 23.16 ± 3.47 kg/m2 in the control group (P < .001). CONCLUSIONS In patients with mesenteric panniculitis, the Doppler spectrum of the superior mesenteric artery shows detectable changes, which are characterized by decreased vascular resistance and increased blood flow.
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Affiliation(s)
- Berat Acu
- Department of Radiology, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mehmet Emrah Güven
- Department of Radiology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Mehmet Ali Kaptan
- Department of Radiology, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Çiğdem Öztunalı
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Erkan Gökçe
- Department of Radiology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Murat Beyhan
- Department of Radiology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Taylan Kara
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
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Nyberg L, Björk J, Björkdahl P, Ekberg O, Sjöberg K, Vigren L. Sclerosing mesenteritis and mesenteric panniculitis - clinical experience and radiological features. BMC Gastroenterol 2017; 17:75. [PMID: 28610559 PMCID: PMC5470176 DOI: 10.1186/s12876-017-0632-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sclerosing mesenteritis (SM) is sometimes used as an umbrella-term for idiopathic inflammatory conditions in the mesentery. Mesenteric panniculitis (MP) is a radiological finding and its relation to clinical SM is not fully understood. The aims of this study were to determine whether any correlation could be found between the radiological findings and the clinical disease course. METHODS Patients observed due to idiopathic inflammation of the mesentery were identified. If SM could be verified histologically or MP radiologically, the patients were included in this descriptive retro perspective study. RESULTS Typical radiological changes were observed in 27 patients. A majority (23/27) of these patients had mild to moderate symptoms. This group with typical radiology was labelled MP. Four patients were included due to histologically verified disease but had uncharacteristic radiology involving multiple compartments of the abdomen. All four had marked systemic inflammation, fever and fluctuating radiologic findings. Three had severe disease with multiple hospitalisations and complications but responded promptly to corticosteroids. This group was denoted SM. CONCLUSIONS We have identified two subgroups of patients; firstly, MP with stable and characteristic radiologic changes and secondly SM with atypical radiology and a more aggressive clinical course. We propose that the term SM should be reserved for this latter condition.
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Affiliation(s)
- Lisa Nyberg
- Department of Medicine, Division of Gastroenterology, Hospital of Trelleborg, Trelleborg, Sweden.
| | - Jan Björk
- Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Björkdahl
- Department of Radiology, Division of Surgery, Ystad Hospital, Ystad, Sweden
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Klas Sjöberg
- Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Lina Vigren
- Department of Medicine, Division of Gastroenterology, Hospital of Trelleborg, Trelleborg, Sweden
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Sahin A, Artas H, Eroglu Y, Tunc N, Demirel U, Bahcecioglu IH, Yalniz M. An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis. Med Princ Pract 2017; 26:567-572. [PMID: 29073610 PMCID: PMC5848480 DOI: 10.1159/000484605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/26/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of mesenteric panniculitis (MP) and to describe its clinical characteristics, therapy, and outcome. SUBJECTS AND METHODS This retrospective study was carried out among patients with MP based on computed tomography (CT) scans from January 2012 to December 2015. The CT images were reanalyzed by study radiologists to confirm the previous MP diagnosis. Patients were divided into 2 groups, i.e., idiopathic and secondary, based on the presence or absence of associated predisposing factors such as trauma, malignancy, autoimmune disorders, ischemia, or previous abdominal surgery. The clinical characteristics of the 2 groups, as well as treatments, were assessed. RESULTS Among the 19,869 CT scans, 36 patients (0.18%) with MP were identified (i.e., 19 [53%] females and 17 [47%] males). The median age was 54 years (range 26 - 76). Twenty-four patients (67%) were categorized into the idiopathic group. Malignancy was the predisposing factor in 8 (22%) of those patients. Furthermore, abdominal pain was the cardinal symptom observed in 22 patients (92%) in the idiopathic group. In the idiopathic group, 15 patients (63%) were treated with antibiotics and 16 (67%) were treated with nonsteroidal anti-inflammatory drugs (NSAID). One unresponsive patient was treated with colchicine. Symptomatic relief was achieved in all of the treated patients. CONCLUSION In this study, a symptomatic idiopathic subgroup of patients with MP did not have any associated disorder. The response to treatment with antibiotics and NSAID was effective in most of the patients. Based on these findings, anti-inflammatory treatments beyond NSAID and surgery should be reserved for patients who are unresponsive to antibiotics and NSAID.
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Affiliation(s)
- Abdurrahman Sahin
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
- *Abdurrahman Sahin, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Yunus Emre Avenue 20, TR-23119 Elazig (Turkey), E-Mail
| | - Hakan Artas
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Yesim Eroglu
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Nurettin Tunc
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Ulvi Demirel
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | | | - Mehmet Yalniz
- Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
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Ehrenpreis ED, Roginsky G, Gore RM. Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms. World J Gastroenterol 2016; 22:10601-10608. [PMID: 28082812 PMCID: PMC5192271 DOI: 10.3748/wjg.v22.i48.10601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography (CT). METHODS All abdominal CT scans performed at NorthShore University HealthSystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet (RadNet Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records. RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fifty-nine patients had mesenteric panniculitis (MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients (22.6%) had a known history of cancer at the time of their CT scan. Nineteen (5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these (14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MP-like findings on CT (36 cases, 36%), with follicular lymphoma being the most frequent subtype (17/36). A variety of solid tumors, most commonly prostate (7) and renal cell cancers (6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45 (80%), worsened in 6 (11%), and improved in 5 patients (9%). Positron emission tomography (PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients (5%). CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.
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Protin-Catteau L, Thiéfin G, Barbe C, Jolly D, Soyer P, Hoeffel C. Mesenteric panniculitis: review of consecutive abdominal MDCT examinations with a matched-pair analysis. Acta Radiol 2016; 57:1438-1444. [PMID: 26868171 DOI: 10.1177/0284185116629829] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The relationship between mesenteric panniculitis (MP), a benign condition involving adipose mesenteric tissue, and malignancy is still being questioned. Purpose To investigate the prevalence of MP and study its relationship with malignancy. To investigate the 5-year outcome of MP patients for the development of malignancy. Material and Methods Retrospective search for MP reviewing 3054 consecutive multidetector row computed tomography (MDCT) scans. Two radiologists in consensus selected the final MP population. For each MP, two subsequent MDCT scans of patients matched by gender and age. Five-year follow-up data regarding cancer occurrence after index MDCT scans were obtained for the MP and control groups. Comparisons between groups were performed using univariate conditional logistic regression. Results A total of 160 patients had at least three of the five MDCT features defining MP. Sixty-four were excluded owing to disease causing mesenteric infiltration or contiguous neoplastic involvement. The final population included 96 MP and 192 control patients. The prevalence of MP was 3.14%. Most cases of MP were discrete (66.7%), 2.1% were marked. In total, 60.4% and 59.4% of MP and control patients, respectively, had cancer ( P = 0.86). There was no significant association between MP score and presence of cancer ( P = 0.06) nor any relationship between the course of associated cancer and MP evolution. In total, 80/96 MP patients and 50/78 control patients without associated cancer had a 5-year follow-up at least. No significant difference between both groups for new tumor occurrence during follow-up was found ( P = 0.15). Conclusion Our results do not suggest that patients with incidentally found MP should be followed up for early detection of a cancer.
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Affiliation(s)
| | - Gérard Thiéfin
- Department of Gastroenterology, Hôpital Robert Debré, Reims, France
| | - Coralie Barbe
- Department of Clinical Research and Statistics, Hôpital Robert Debré, Reims, France
| | - Damien Jolly
- Department of Clinical Research and Statistics, Hôpital Robert Debré, Reims, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Lariboisière, Paris, France
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Klasen J, Güller U, Muff B, Candinas D, Seiler CA, Fahrner R. Treatment options for spontaneous and postoperative sclerosing mesenteritis. World J Gastrointest Surg 2016; 8:761-765. [PMID: 27933138 PMCID: PMC5124705 DOI: 10.4240/wjgs.v8.i11.761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/19/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
Sclerosing mesenteritis is a rare pathology with only a few described cases in the literature. The etiology is unclear; however, several potential triggers, including abdominal surgery and abdominal trauma, have been discussed. The pathology includes a benign acute or chronic inflammatory process affecting the adipose tissue of the mesenterium. Despite it being a rare disease, sclerosing mesenteritis is an important differential diagnosis in patients after abdominal surgery or patients presenting spontaneously with signs of acute inflammation and abdominal pain. We present here three cases with sclerosing mesenteritis. In two cases, sclerosing mesenteritis occurred postoperatively after abdominal surgery. One patient was treated because of abdominal pain and specific radiological signs revealing spontaneous manifestation of sclerosing mesenteritis. So far there are no distinct treatment algorithms, so the patients were treated differently, including steroids, antibiotics and watchful waiting. In addition, we reviewed the current literature on treatment options for this rare disease.
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Kuriyama A. 'Halo' from the Belly: Mesenteric Panniculitis. Am J Med 2016; 129:e291-e292. [PMID: 27427318 DOI: 10.1016/j.amjmed.2016.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Akira Kuriyama
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan.
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Apostolakis S, Ioannidis A, Tsioga G, Papageorgiou K, Velimezis G. A systematic investigation of sclerosing mesenteritis through CT and MRI. Radiol Case Rep 2016; 11:299-302. [PMID: 27920848 PMCID: PMC5128563 DOI: 10.1016/j.radcr.2016.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022] Open
Abstract
Sclerosing mesenteritis is primarily diagnosed through histologic and radiologic evaluation; however, only a few works provide a systematic description using MRI. This work presents the case of a 68-year-old male, who was admitted for a routine cholecystectomy. Intraoperativly, a large mass was identified dislocating the abdominal viscera. The microscopic examination revealed vascular congestion of the omentum. The contrast-enhanced CT and MRI scans revealed the presence of a heterogenous, lipomatous mass with lesions visible only in T2W and contrast-enhanced T1W MRI. Based on these findings, the diagnosis of sclerosing mesenteritis was made. According to the available literature, depending on the stage of sclerosing mesenteritis, different radiologic features are encountered; however, it is possible that features from more than one form of the condition coexist in the same lesion. We therefore suggest that a combination of MRI sequences should be acquired for a more accurate staging of the condition.
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Affiliation(s)
- Sotirios Apostolakis
- Department of Surgery, Sismanoglion Hospital, 1 Sismanogliou street, Amarousion 15126, Greece
| | - Argyrios Ioannidis
- Department of Surgery, Sismanoglion Hospital, 1 Sismanogliou street, Amarousion 15126, Greece
| | - Garyfalia Tsioga
- Magnetic Resonance Imaging Department, Sismanoglion Hospital, Amarousion, Greece
| | | | - Georgios Velimezis
- Department of Surgery, Sismanoglion Hospital, 1 Sismanogliou street, Amarousion 15126, Greece
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Nuzzo A, Zappa M, Cazals-Hatem D, Bouhnik Y. Crohn's disease mistaken for long-standing idiopathic mesenteric panniculitis: A case report and management algorithm. Medicine (Baltimore) 2016; 95:e5073. [PMID: 27684882 PMCID: PMC5265975 DOI: 10.1097/md.0000000000005073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mesenteric panniculitis (MP) is mostly an associated sign of an intra-abdominal or systemic inflammatory primary disease. Nevertheless, etiological and differential diagnosis of idiopathic MP can be challenging when an associate primary cause is not in the foreground. METHODS We report here the case of an isolated small bowel Crohn's disease, long time considered as idiopathic MP. RESULTS This patient presented to our department with a 10-year history of acute abdominal symptoms evolving with flare-up and remission. A diagnosis of idiopathic MP was made based on compatible CT-scan features along with normal laboratory tests and upper and lower bowel endoscopies. As symptoms recurred, a steroid course was proposed which dramatically improved his condition for years. Finally, an explorative laparoscopy was performed because of concern of malignancy when he returned to our unit with a steroid refractory flare-up and weight loss, along with MP nodes growing up to 10 mm. Crohn's disease was eventually diagnosed, based on histopathological middle-gut bowel resection and numerous granulomas in mesenteric nodes without necrosis. CONCLUSION This case emphasizes the importance of excluding inflammatory intestinal lesions before making the diagnosis of idiopathic MP (fecal calprotectin, magnetic resonance enterography, wireless capsule endoscopy).
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Affiliation(s)
- Alexandre Nuzzo
- Department of Gastroenterology, IBD and Nutritional Support
- Correspondence: Alexandre Nuzzo, DHU UNITY, Pôle des Maladies de l’Appareil Digestif, Hôpital Beaujon—Assistance Publique des Hôpitaux de Paris (APHP), Université Paris VII (Denis Diderot), 100 Boulevard du Général Leclerc, 92110 Clichy, France (e-mail: )
| | | | | | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutritional Support
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Buchwald P, Diesing L, Dixon L, Wakeman C, Eglinton T, Dobbs B, Frizelle F. Cohort study of mesenteric panniculitis and its relationship to malignancy. Br J Surg 2016; 103:1727-1730. [DOI: 10.1002/bjs.10229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/13/2016] [Accepted: 05/13/2016] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Mesenteric panniculitis (MP) is a rare condition that historically has been associated with the presence of malignancy. Paraneoplastic phenomena in general regress with cure and in most cases with treatment of the cancer. This study was undertaken to determine whether MP regressed with cancer treatment and cure.
Methods
This was a retrospective review of a database of all patients with MP confirmed on CT between 2003 and August 2015 at Christchurch Hospital. Patients were categorized as having malignant or non-malignant disease, and follow-up scans were assessed for remission of MP. Patients with malignancy were further categorized as having malignancy cured or not cured.
Results
A total of 308 patients were identified with possible MP; 135 were excluded as radiological appearances were not typical of MP (43 patients) or there was no follow-up CT (92). Of 173 patients (131 men) included, 75 (43·4 per cent) were diagnosed with malignancy. Follow-up imaging showed that 33 patients (19·1 per cent) had remission of MP, whereas 140 (80·9 per cent) had no remission. There was no difference in the rates of MP remission in the malignancy versus no malignancy groups (P = 1·000), or between groups in which malignancy was cured or not cured (P = 0·572). Nor was there any difference in the rates of MP remission in malignancy cured versus no malignancy groups (P = 0·524).
Conclusion
MP does not behave like a paraneoplastic phenomenon. The association with malignancy is most likely an epiphenomenon of the many CT images acquired for staging of cancer.
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Affiliation(s)
- P Buchwald
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - L Diesing
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - L Dixon
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - C Wakeman
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - T Eglinton
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - B Dobbs
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - F Frizelle
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
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Mesenteric panniculitis: systematic review of cross-sectional imaging findings and risk of subsequent malignancy. Eur Radiol 2016; 26:4531-4537. [PMID: 27048526 PMCID: PMC5101267 DOI: 10.1007/s00330-016-4298-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/17/2022]
Abstract
Objectives Systematic review to determine any association between imaging features of idiopathic mesenteric panniculitis (MP) and subsequent malignancy. Methods Two researchers searched primary literature independently for imaging studies of MP. They extracted data focusing on methodology for unbiased patient accrual and capability to determine a link between MP and subsequent malignancy. They noted imaging features of MP. Data were accrued and meta-analysis intended. Results Fourteen of 675 articles were eligible; 1,226 patients. Only three (21 %) accrued patients prospectively. Twelve (86 %) studies described CT features. Follow-up varied widely; 1 month to 8 years. Prevalence of MP was influenced by accrual: 0.2 % for keyword search versus 1.7 % for consecutive series. Accrual bias affected nine (64 %) studies. 458 (38 %) of 1,209 patients had malignancy at accrual but varied widely (8–89 %), preventing meta-analysis. Sixty (6.4 %) of 933 patients developed new malignancy subsequently, also varying widely (0–11 %). Of just four studies that determined the proportion of unselected, consecutive patients with MP developing subsequent malignancy, three were retrospective and the fourth excluded patients with lymphadenopathy, likely excluding patients with MP. Conclusion Studies were heterogeneous, with biased accrual. No available study can determine an association between MP and subsequent malignancy with certainty. Key Points • Our systematic review of mesenteric panniculitis found that imaging studies were biased. • Spectrum and recruitment bias was largely due to retrospective study designs. • No study could confirm a certain link between mesenteric panniculitis and subsequent malignancy. • Excessive methodological heterogeneity precluded meaningful meta-analysis. • High-quality research linking mesenteric panniculitis imaging features and subsequent malignancy is needed.
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Cross AJ, McCormick JJ, Griffin N, Dixon L, Dobbs B, Frizelle FA. Malignancy and mesenteric panniculitis. Colorectal Dis 2016; 18:372-7. [PMID: 26467030 DOI: 10.1111/codi.13154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/30/2015] [Indexed: 02/08/2023]
Abstract
AIM Mesenteric panniculitis (MP) is a chronic inflammatory process of the small bowel mesentery that has been reported in conjunction with malignancy. The objectives of the present study were to identify the frequency and type of cancers that may coexist with MP and whether these can be seen on the initial diagnostic computerised tomography (CT). METHOD A prospective database was kept of patients diagnosed with MP in the Canterbury region of New Zealand between 1 January 2003 and 31 December 2014. CT scans were independently reviewed. Clinical records were reviewed and family doctors were contacted for additional information. RESULTS There were 302 patients with possible MP identified and 259 in whom it was confirmed on review. Seventy-eight patients had a diagnosis of malignancy, with 54 having a current cancer (59 total cancers), 33 a past cancer and nine both. Of the 59 current cancers the most common primary sites were colorectum (19), lymph nodes (17), kidney (six) and prostate (four). Fifty-four were at sites included on an abdominal CT scan. At all sites [except prostate (0/4)] there were high rates of detection on CT with 44/54 cancers visible including 20/23 gastrointestinal tract, 14/17 lymphomas and 9/9 non-prostate urogenital tract malignancies. Six people were subsequently diagnosed with cancer after the index CT. CONCLUSION When MP occurs in association with malignancy, the commonest primary sites are large bowel, the lymph nodes and the urogenital tract. In those with MP on imaging, any cancer except prostate can usually be seen on the index CT. Further extensive investigation in asymptomatic patients is therefore likely to be of low yield.
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Affiliation(s)
- A J Cross
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - J J McCormick
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - N Griffin
- Department of Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - L Dixon
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - B Dobbs
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - F A Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
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Tavares Pereira JP, Romão V, Eulálio M, Jorge R, Breda F, Calretas S, Leitão S, Eugénio G, Santos R, Carvalho A. Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:55-9. [PMID: 26848804 PMCID: PMC4743678 DOI: 10.12659/ajcr.896145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sclerosing mesenteritis is an idiopathic inflammatory and fibrotic disease that affects the mesentery. It is a rare disease, with the total number of reported cases in the literature ranging from 122 to 300. It mainly affects men in the sixth decade of life, and its etiology remains unknown. Clinical presentation is variable, but it is frequently asymptomatic. Diagnosis is often made by computed tomography (CT) scan, although biopsy may be needed for confirmation. An association between other diseases (e.g., neoplasms) and sclerosing mesenteritis has been described, but the relationship between the latter and glucose changes is not disclosed in the currently available literature. CASE REPORT Five cases of sclerosing mesenteritis and glucose metabolism disorders (impaired fasting glucose and type 2 diabetes mellitus) were retrospectively collected and analyzed. The mean age was 65 ± 9.3 years, 80% were male, and all patients were white. Three patients were asymptomatic and the other 2 (40%) had non-specific chronic abdominal pain. Blood tests revealed normal inflammatory parameters (mean HbA1c was 6.4% and fasting blood glucose was 140 mg/dL). The diagnosis was made by abdominal CT scan. The 2 symptomatic patients underwent therapy with colchicine 1 mg/day, with clinical improvement. During the mean 43-month follow-up period, there was no symptomatic progression, thereby maintaining the usual benign course of this condition. CONCLUSIONS Sclerosing mesenteritis has only been described in small series and isolated cases, but its diagnosis is becoming more common due to greater access to diagnostic methods and higher awareness of the disease in the medical community. Furthermore, despite the small sample size, we describe a possible association between glucose metabolism impairment and sclerosing mesenteritis.
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Affiliation(s)
| | - Vera Romão
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Eulálio
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rita Jorge
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Filipe Breda
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Suzana Calretas
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Leitão
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gisela Eugénio
- Department of Rheumatology, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Santos
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
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Affiliation(s)
- P Soyer
- Department of Abdominal Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France; Université de Reims Champagne-Ardennes, 51, rue Cognacq-Jay, 51100 Reims, France
| | - M Zins
- Department of Radiology, fondation hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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