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DOI: 10.1055/s-0042-1743588
Mesenteric Panniculitis, Sclerosing Mesenteritis and Mesenteric Lipodystrophy: Descriptive Review of a Rare Condition
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Abstract
Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis.
There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions.
While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.
Keywords
mesenteric panniculitis - mesenteric lipodystrophy - sclerosing mesenteritis - retractile mesenteritis - mesenteric fibrosis - neoplasms - lymphoma - paraneoplastic conditions - laparoscopy - computerized tomography - positron emission tomography - adipose tissue - lymphatics - autoimmune diseasePublication History
Article published online:
10 August 2022
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References
- 1 Coffey JC, O'Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2016; 1 (03) 238-247 DOI: 10.1016/S2468-1253(16)30026-7.
- 2 Ehrenpreis E. Mesenteric Panniculitis. NORD Rare Disease Database. Published 1988. Updated 2020. Accessed 3/1/2021. https://rarediseases.org/rare-diseases/mesenteric-panniculitis/
- 3 Emory TS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity?. Am J Surg Pathol 1997; 21 (04) 392-398 DOI: 10.1097/00000478-199704000-00004.
- 4 Kuhrmeier A. Mesenteriale lipodystrophie. [Mesenteric lipodystrophy]. Schweiz Med Wochenschr 1985; 115 (36) 1218-1224
- 5 Daskalogiannaki M, Voloudaki A, Prassopoulos P. et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. Am J Roentgenol 2000; 174 (02) 427-431 DOI: 10.2214/ajr.174.2.1740427.
- 6 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 (48) 10601-10608 DOI: 10.3748/wjg.v22.i48.10601.
- 7 Sharma P, Yadav S, Needham CM, Feuerstadt P. Sclerosing mesenteritis: a systematic review of 192 cases. Clin J Gastroenterol 2017; 10 (02) 103-111 DOI: 10.1007/s12328-017-0716-5.
- 8 Green MS, Chhabra R, Goyal H. Sclerosing mesenteritis: a comprehensive clinical review. Ann Transl Med 2018; 6 (17) 336 DOI: 10.21037/atm.2018.07.01.
- 9 Gonzalez RS. Sclerosing mesenteritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonsclerosingmes.html. Accessed July 7th, 2021.
- 10 Bala A, Coderre SP, Johnson DR, Nayak V. Treatment of sclerosing mesenteritis with corticosteroids and azathioprine. Can J Gastroenterol 2001; 15 (08) 533-535 DOI: 10.1155/2001/462823.
- 11 Horton KM, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 2003; 23 (06) 1561-1567 DOI: 10.1148/rg.1103035010.
- 12 Kaya C, Bozkurt E, Yazıcı P, İdiz UO, Tanal M, Mihmanlı M. Approach to the diagnosis and treatment of mesenteric panniculitis from the surgical point of view. Turk J Surg 2018; 34 (02) 121-124 DOI: 10.5152/turkjsurg.2018.3881.
- 13 Mori E, Kamisawa T, Tabata T. et al. A case of IgG4-related mesenteritis. Clin J Gastroenterol 2015; 8 (06) 400-405 DOI: 10.1007/s12328-015-0617-4.
- 14 Butt Z, Alam SH, Semeniuk O, Singh S, Chhabra GS, Tan IJ. A Case of IgG4-related Sclerosing Mesenteritis. Cureus 2018; 10 (02) e2147 DOI: 10.7759/cureus.2147.
- 15 Avincsal MO, Otani K, Kanzawa M. et al. Sclerosing mesenteritis: a real manifestation or histological mimic of IgG4-related disease?. Pathol Int 2016; 66 (03) 158-163 DOI: 10.1111/pin.12386.
- 16 Minato H, Shimizu J, Arano Y. et al. IgG4-related sclerosing mesenteritis: a rare mesenteric disease of unknown etiology. Pathol Int 2012; 62 (04) 281-286 DOI: 10.1111/j.1440-1827.2012.02805.x.
- 17 Wilkes A, Griffin N, Dixon L, Dobbs B, Frizelle FA. Mesenteric panniculitis: a paraneoplastic phenomenon?. Dis Colon Rectum 2012; 55 (07) 806-809 DOI: 10.1097/DCR.0b013e318252e286.
- 18 Scheer F, Spunar P, Wiggermann P, Wissgott C, Andresen R. [Mesenteric panniculitis (MP) in CT - a predictor of malignancy?]. RoFo Fortschr Geb Rontgenstr Nuklearmed 2016; 188 (10) 926-932 DOI: 10.1055/s-0042-110100.
- 19 Buchwald P, Diesing L, Dixon L. et al. Cohort study of mesenteric panniculitis and its relationship to malignancy. Br J Surg 2016; 103 (12) 1727-1730 DOI: 10.1002/bjs.10229.
- 20 Smith ZL, Sifuentes H, Deepak P, Ecanow DB, Ehrenpreis ED. Relationship between mesenteric abnormalities on computed tomography and malignancy: clinical findings and outcomes of 359 patients. J Clin Gastroenterol 2013; 47 (05) 409-414 DOI: 10.1097/MCG.0b013e3182703148.
- 21 Ogden II WW, Bradburn DM, Rives JD. Mesenteric panniculitis: review of 27 cases. Ann Surg 1965; 161 (06) 864-875 DOI: 10.1097/00000658-196506000-00006.
- 22 Roginsky G, Mazulis A, Ecanow JS, Ehrenpreis ED. Mesenteric panniculitis associated with Vibrio cholerae infection. ACG Case Rep J 2015; 3 (01) 39-41 DOI: 10.14309/crj.2015.95.
- 23 Avelino-Silva VI, Leal FE, Coelho-Netto C. et al. Sclerosing mesenteritis as an unusual cause of fever of unknown origin: a case report and review. Clinics (São Paulo) 2012; 67 (03) 293-295 DOI: 10.6061/clinics/2012(03)16.
- 24 Lee KJ, Ehrenpreis ED, Greenberg J, Yang GY, Horowitz J. Mesenteric panniculitis following colonoscopy, polypectomy, and epinephrine injection. Endoscopy 2010; 42 (Suppl. 02) E44-E45 DOI: 10.1055/s-0029-1215259.
- 25 Ginsburg PM, Ehrenpreis ED. A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis. Aliment Pharmacol Ther 2002; 16 (12) 2115-2122 DOI: 10.1046/j.1365-2036.2002.01383.x.
- 26 Akram S, Pardi DS, Schaffner JA, Smyrk TC. Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin Gastroenterol Hepatol 2007; 5 (05) 589-596 , quiz 523–524. Doi: 10.1016/j.cgh.2007.02.032
- 27 Sabaté JM, Torrubia S, Maideu J, Franquet T, Monill JM, Pérez C. Sclerosing mesenteritis: imaging findings in 17 patients. Am J Roentgenol 1999; 172 (03) 625-629 DOI: 10.2214/ajr.172.3.10063848.
- 28 Badet N, Sailley N, Briquez C, Paquette B, Vuitton L, Delabrousse É. Mesenteric panniculitis: still an ambiguous condition. Diagn Interv Imaging 2015; 96 (03) 251-257 DOI: 10.1016/j.diii.2014.12.002.
- 29 Mindelzun RE, Jeffrey Jr RB, Lane MJ, Silverman PM. The misty mesentery on CT: differential diagnosis. Am J Roentgenol 1996; 167 (01) 61-65 DOI: 10.2214/ajr.167.1.8659422.
- 30 Montgomery E, Torbenson MS, Kaushal M, Fisher C, Abraham SC. Beta-catenin immunohistochemistry separates mesenteric fibromatosis from gastrointestinal stromal tumor and sclerosing mesenteritis. Am J Surg Pathol 2002; 26 (10) 1296-1301 DOI: 10.1097/00000478-200210000-00006.
- 31 Coulier B. Mesenteric panniculitis. Part 2: prevalence and natural course: MDCT prospective study. JBR-BTR 2011; 94 (05) 241-246 DOI: 10.5334/jbr-btr.659.
- 32 Généreau T, Bellin MF, Wechsler B. et al. Demonstration of efficacy of combining corticosteroids and colchicine in two patients with idiopathic sclerosing mesenteritis. Dig Dis Sci 1996; 41 (04) 684-688 DOI: 10.1007/BF02213123.
- 33 Tytgat GN, Roozendaal K, Winter W, Esseveld MR. Successful treatment of a patient with retractile mesenteritis with prednisone and azathioprine. Gastroenterology 1980; 79 (02) 352-356
- 34 Bush RW, Hammar Jr SP, Rudolph RH. Sclerosing mesenteritis. Response to cyclophosphamide. Arch Intern Med 1986; 146 (03) 503-505
- 35 Farrar MC, Jacobs TF. Tamoxifen. [Updated 2021 Apr 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532905/
- 36 Roginsky G, Alexoff A, Ehrenpreis ED. Initial findings of an open-label trial of low-dose naltrexone for symptomatic mesenteric panniculitis. J Clin Gastroenterol 2015; 49 (09) 794-795 DOI: 10.1097/MCG.0000000000000398.
- 37 Durst AL, Freund H, Rosenmann E, Birnbaum D. Mesenteric panniculitis: review of the leterature and presentation of cases. Surgery 1977; 81 (02) 203-211
- 38 Ehrenpreis ED, Rao AS, Aki R, Brown H, Pae T, Boiskin I. Normal positron emission tomography-computerized tomogram in a patient with apparent mesenteric panniculitis: biopsy is still the answer. Case Rep Gastroenterol 2009; 3 (01) 131-137 DOI: 10.1159/000213653.