Mesenteric Panniculitis – Definition, Symptoms, Causes, Treatment

What is Mesenteric Panniculitis?

Panniculitis refer to the inflammation of the fatty deposits or adipose tissue that can be seen most particularly in the abdominal area. Mesenteric Panniculitis is a rare inflammatory disease that affects the subcutaneous adipose tissue of the mesentery or the small bowel area that is characterized by blockage to the small intestine. It was first referred to as retractile mesentery by Jura in 1024 and was renamed as mesenteric panniculitis by Odgen in 1960.

There have been so many terms being used to refer to the disease, but today it was classified into one disease of two categories; the mesenteric panniculitis and retractile mesentiritis. It is known as mesenteric panniculitis if the inflammation and fat necrosis is more than the fibrosis, whereas retractile mesentiritis if fibrosis dominates.

Also, another distinguishing characteristic of mesenteric panniculitis if the presence of mesenteric lipodystrophy by fat necrosis, chronic inflammation and retractile mesenteritis by fibrosis.

There is a higher of incidence report in middle aged males compared to females, and it is common in Caucasian males. Studies also show that as person ages, the risk to have possibly had the disease also increases. On the contrary, there is no incidence yet reported on the occurrence of the disease to pediatric patients, maybe because they have less fats, which is the major contributing factor of the disease, as compared to adults.

Mesenteric Panniculitis Image

Ct Scan Imaging to depict presence of Mesenteric Panniculitis

Symptoms and Signs

Because it affects most on the abdominal area, the symptoms are also related to the affected system and may last for some time or even more than a year. Although it appears to be showing no symptoms at all, its manifestation differs between individuals and cases. The disease may present symptoms such as:

  • Abdominal pain of varying intensity
  • Loss of appetite
  • Back pain
  • Nausea
  • Fever
  • Weight loss
  • Abdominal fullness
  • Palpable abdominal mass
  • Constipation or diarrhea
  • Passage of blood in the rectum

In some instances, the patient may not show any physical manifestation unless with the aid of some diagnostic assessment. Other patient also report to experience to have jaundice, acute abdomen and abdominal obstructions. With the different manifestation of the disease will also entail several illnesses that have to be taken into consideration.

Mesenteric Panniculitis Causes

There is no known specific cause of the disease and until today it is still unclear for those who are in the medical profession. However, there are some predisposing factors that can lead to the development of the disease.

Mesenteric panniculitis is believed to affect to those people who undergone surgery. Tumor and other inflammatory condition affecting the abdomen cannot be discounted in contributing to the occurrence of the disease. Autoimmune diseases like SLE, Thyroid disease and other related condition are also said to cause the disease.

The condition is also said to be linked to the progression of the disease are mesenteric arteriopathy, chemical, thermal and drug injuries, avitaminosis, pancreatitis, leakage of bile or urine, and bacterial infection.

There are also some other factors like gallstones, heart diseases, peptic ulcer, cirrhosis, abdominal aortic aneurism, are said to also contribute to cause the disease. There are also some studies that claim of the significant relationship of tobacco smoking to mild mesenteric panniculitis.

On the other hand, Retractile Mesentiric is associated with those diseases that have something to do with fibrose tissue. These disease are related to malignant disease such as lymphoma, melanoma. Hodgkin’s disease, renal cancer cells, and other types of cancer.

Mesenteric Panniculitis Diagnosis

Because of the extensive effect of the disease, the assessment and diagnosis also differ depending on the presenting factor it has of the individual.

Abdominal Computed tomography is believe to be the most preferred in finding the abdominal mass present on the body. This will also somehow help in identifying the presence of the “fat ring” sign that shows the presence of fat deposits and the “tumor pseudocapsule”. But, CT scan does not help in the diagnosis of the disease since they are thought to have no clear impressions. The presence of the disease in the CT scan appears to be soft tissue mass being covered by a mesenteric vessel that later progress into collateral vessels.

The presence of fat around the mesenteric vessels was referred to as the fats ring sign. This feature makes it differs to other condition of the same origin such as lymphoma, carcinomatosis or carcinoid tumor. Another thing that also needs to be considered it the appearance of the mesentery in the CT scan, it’s misty appearance are also the same characteristic that are being displayed by haemorrhage, edema or lymphoma.

A more definite diagnostic tool is the MRI. It reveals the existence of fibrous capsule that cannot be identified by other diagnostic tools. Still surgical biopsy remains to be the almost precise and acceptable diagnostic evaluation to determine the presence of Mesenteric Panniculitis since they can provide a complete histologic analysis.

Histological examinations are also significant in confirming the occurrence of the disease but they are not as definitive as the radiologic examinations. Blood works will reveal a normal value.

Histological Examination Image

Histological Examination to diagnose presence of Mesenteric Panniculitis

There are some radiologic examinations that can be used to identify the presence of Mesenteric Panniculitis, yet their reliability is still in question.

Mesenteric Panniculitis Treatment

The treatment of Mesenteric Panniculitis depends on the severity of the condition and there is no definite or universally accepted form of treatment for the disease. Correct diagnosis must be undertaken before doing any treatment since looking for the exact finding of the condition is often difficult.

The most common therapy is with the use of steroids, colchicine, tamoxifen, cyclophosphamide, progesterone, antibiotics and a lot more. Prednisone is known to have a favourable effect and delivers the quickest response among corticosteroids. The effects of these medicines have different rate of success and its effectiveness varies also among individuals.

If medication therapy be unsuccessful, surgical treatment might be done if it entails a life-threatening situation occurs and a colostomy may be created, although there are some medical practitioner who do not prefer for such option.

Their reason of opposing to surgery is that it might aggravate the condition. In benign cases, surgical resection has proven to cause progression of the condition thus leading to death of the patient. If surgical treatment is to be pursued, then a medical history review is encourage to prevent other complications in occurring.

Surgical Resection to diagnose presece of mesenteric panniculitis image

Surgical Resection to diagnose presence of Mesenteric Panniculitis

On the other hand, radiation therapy are said to be not useful and no proven effect in the resolution of the disease.

Radiation Therapy Image

Radiation Therapy to treat Mesenteric Panniculitis

Mesenteric Panniculitis Prognosis

The overall prognosis of the disease is good, although there are some very few instances of recurrence. On the other hand, it should also be noted that the success of the treatment is inconsistent and depend on the severity of the condition.

There are some incidents that because the patients are asymptomatic, they will seek treatment if conditions are already classified as malignant.

19 Replies to “Mesenteric Panniculitis – Definition, Symptoms, Causes, Treatment”

  1. I’m just recently been diagnosed with mesenteric panniculitis with lymph nodes and misty mesentery. I have been recommended to see a gastro and rheumatologist after two trips to ER seen My Dr. put on Steroids, have lost 60 lbs. I am scheduled.for colonoscopy / EGD, Mammo and rheumatology Dr…I am still in severe pain wondering how to cope. Insomnia, pain and Nausea with rectal bleeding have been going on for almost 6 weeks.

    1. I have had this disease for almost five years, my pain is intermittent. The doctors have tried putting me on low grade continual antibiotics and then switching them out every six months, I am presently on a sulphur type drug and I am still kicking and alive. Drs. at Mayo clinic refused to operate on the large mass with tentacles in my abdomen.

  2. what foods should you eat when you have mesenteric panniculitus . should I eat any fruits and vegetables or fiber? than you

  3. I have just been told i have mesentery panniculitis,my own doctor has not bothered to look at the letter i received from hospital,i am upset and still in pain could you give me some advice please.have got no treatment,

  4. I was diagnosed with messenteric panniculits over 2 years ago. The consultant told me to go and live my life the best I could, because steroids would make me feel worse than the disease. Not very helpful! My GP put me on amitriptyline, omoprozal, and movecal. I am still suffering but more intermittently now. Has anybody got any better medication that may be better.

    1. These tablets have got nothing to do with what you have got ,the G.P.,just do not want to know we will have to resolve things ourselves,and stand up to them,let me know how you get on.

  5. where can we go for any advice,treatment,diet or any thing to make things better.Are there any groups on the subject,if not we could start one???????

    1. Please go to Facebook and search Sclerosing Mesenteritits. It’s a wonderful forum with tons of support and information!

  6. I was just told yesterday I have mesentericpaniculitis. What can I expect from this besides alot of pain I don’t no w h at to do.

  7. I found out yesterday I have panniculitis. 6 months ago I started getting sores down below my belly button across abdomen .numb feeling of testicles. Went to doc and he told me it was my weight. I have panniculitis. That I was at age 19 now that I have 5 years to lose my weight cause if I don’t I won’t live to see 30. The reason he tell me this he has the disease. He use to be large man like me 10 year ago. Doc told him same. He is 62 year old. Having to live with disease. He told me with all my weight will be strain on my body and I won’t be able to live with disease. I am very scared I do not understand people tell me that this disease will kill me if I do not lose weight. Tell me disease destroy my liver lungs even my blood cells. Telling me I’m already 1 foot in grave.
    My physician is stupid prescribe me med for yeast infection. Had to find out I have panniculitis through a specialist that check my man parts. Please any more info on disease please send my way. Sometime I feel I should give up so many health probs at once is just to much for me.

  8. Hello,just was giving the bad news yesterday.I know what iam going to treat this problem with and that’s sovereign silver and food grade hydrogen peroxide,French green clay.If I had only one choice it would be the silver.

  9. i had been diagnosed with mesentary paniculitis 6 yrs ago. surgery took out 3 masses. took my spleen no documentation why. Was fine did good on fresh food diet for a while. had accident car back injury so i have been in enormous pain hurts to walk alot. now i just got the side pain and memories come back. Dont even have to ask i remember this pain, there is no pain like this. Here we go again. steroids to start with. going back next week.

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