A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China.

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.

Association between mesenteric panniculitis and urolithiasis.

BACKGROUND: Mesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat. OBJECTIVES: This study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis. MATERIALS AND METHODS: In this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation. RESULTS: Mesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis. CONCLUSION: Mesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.

Mesenteric panniculitis associated with non-alcoholic fatty liver disease: A case series.

Mesenter ic p anniculitis (MP) is a b enign infla mmatory condi tion of the abdomin al mesentery, whi ch presents with a wid e variety of symptoms. I t is diagnosed non - invasively through com puted to mography (CT ) scan, whereas biopsy is still co nside red th e gold standa rd. Steroids are the first line of treatment. Here, we report four cases who presented with abdominal pain. These patients were overweight and the CT scan findings were suggestive of mese nte ric panniculitis. Three cases had concomitant non- alcoholic steatohep atitis w ith el evated alanine transaminase levels, dyslipidaemia, and insulin resistance. FibroSca n showed moderate to severe steatosis. PNPLA3 rs738409 genotype was homozygous positive (GG) in one patient, whereas two patients were heterozygous positive (CG ). This a ssociat io n has not been well-described so far and w arrants f ur ther inve s tigation. There may be some common predisposing factors.

Mesenteric Panniculitis.

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.

Fat Stranding Associated With High-Grade Colon Adenocarcinoma: A Case Report.

Abdominal pain is a common complaint among patients who present to the emergency department. In this setting, a CT scan of the abdomen is frequently used for diagnostic purposes. Fat stranding is an important and relevant CT finding. It is non-specific and can be associated with multiple conditions that range from benign to life-threatening. Although it may not provide the final diagnosis, it can direct the evaluating physician toward an area of concern. This case report describes an 81-year-old female presenting to the emergency department with diffuse abdominal pain. CT of the abdomen/pelvis showed mesenteric fat stranding. She was eventually diagnosed with high-grade adenocarcinoma of the colon. The radiological appearance, pathophysiology, possible etiologies, and clinical significance of fat stranding are discussed.

[Small bowel obstruction with an unusual background]. / Egy szokatlan hátteru vékonybél ileus.

Bevezetés: Kompressziós vékonybél ileus esetét ismertetjük, amelyet a bélfodor nem gyakori, inflammatorikus természetu betegsége, mesenterialis panniculitis idézett elo. A magyar szakirodalomban ilyen közléssel nem találkoztunk. Esetismertetés: A 91 éves férfi akut hasi panaszokkal került kórházba. A vizsgálatokkal vékonybél ileus derült ki. Ennek hátterében mutétkor malignitásra gyanús, bélfodri multinodularis elváltozást fedtünk föl. A biopsziából mesenterialis panniculitist diagnosztizáltunk. A ritka, több nyitott kérdéssel terhelt entitást mutatjuk be az irodalom és a saját észleleteink tükrében. Következtetések: Számos differenciáldiagnosztikai eshetoség figyelembevételével a kórkép szövettanilag igazolható. A diagnózis felállítása után a további teendoket az egyéb leletek és az adott klinikai kontextus gondos elemzése fogja meghatározni.

Paniculitis mesentérica / Mesenteric panniculitis

Introducción: La paniculitis mesentérica es una afección infrecuente. Aparece en la adultez tardía, con manifestaciones clínicas inespecíficas, puede cursar asintomática o caracterizarse por dolor, hinchazón y distensión abdominal, masa palpable a nivel del abdomen. Esto puede ser un hallazgo casual al realizar exploraciones radiológicas. Objetivo: Describir las características clínico-imagenológicas, así como terapéutica empleada en el tratamiento de un paciente con paniculitis mesentérica. Presentación de caso: Se presenta el caso de un paciente blanco, masculino de 59 años. Con antecedentes de hiperlipidemia, con cuadros doloroso abdominal inespecífico, de 6 meses de evolución. Se le realiza tomografía axial computarizada de abdomen simple y E/V donde se observó engrosamiento de la grasa mesentérica y múltiples imágenes nodulares a nivel del mesenterio compatible con paniculitis mesentérica. Desarrollo: La paniculitis mesentérica es una enfermedad de baja prevalencia, con mayor predominio en la sexta década de la vida, es habitualmente un hallazgo incidental en laparotomía exploratoria o tomografía computarizada de abdomen. Conclusiones: Deben conocerse las manifestaciones clínicas y hallazgos imagenológicos de la paniculitis mesentérica, así como las variantes terapéuticas en su tratamiento para evitar las intervenciones quirúrgicas innecesarias(AU)

Introduction: Mesenteric panniculitis is a rare condition. It appears in late adulthood, with nonspecific clinical manifestations, it can be asymptomatic or characterized by pain, swelling and abdominal distension, a palpable mass in the abdomen. This can be a chance finding when performing radiological examinations. Objective: To describe the clinical-imaging characteristics, as well as the therapy used in the treatment of a patient with mesenteric panniculitis. Case report: We report the case of a 59-year-old white male patient, with history of hyperlipidemia, nonspecific abdominal pain and 6 months of evolution. A simple abdominal computed tomography and E / V were performed, showing thickening of the mesenteric fat and multiple nodular images at the level of the mesentery compatible with mesenteric panniculitis. Findings: Mesenteric panniculitis is a low prevalence disease, with greater prevalence in the sixth decade of life, which is usually found incidentally in exploratory laparotomy or abdominal computed tomography. Conclusions: The clinical manifestations and imaging findings of mesenteric panniculitis must be known, as well as the therapeutic variants in its treatment to avoid unnecessary surgical interventions(AU)

Absceso mesentérico inespecífico paniculitis intra-abdominal / Abscess nonspecific mesenteric panniculitis intra-abdominal

El objetivo del presente caso clínico es mostrar los signos y síntomas que puedan determinar diagnósticos presuntivos no claros, cuándo se trata de masas mesentéricas primarias, que pueden simular patologías de origen biliar, compromiso vascular mesentérico, síndromes de FID y patologías ginecológicas dependientes de anexo derecho. La TAC es el patrón diagnóstico, que no cuentan los hospitales de segundo nivel como el nuestro, de manera que las decisiones que se toman en el servicio de emergencias, frente a este tipo de abdomen agudo quirúrgico es una laparotomía exploradora; para evitar complicaciones, no solo en órganos de la cavidad abdominal, sino también de orden legal. Los resultados de la cirugía mostraron la presencia de un masa mesentérica correspondiente a un absceso mesentérico inespecífico compatible con una paniculitis intra-abdominal, patología rara dentro la estadística nacional e internacional. Los síntomas más frecuentes son dolor abdominal, anorexia, plenitud abdominal y pérdida de peso, a veces oclusión intestinal. Otras manifestaciones comprenden: estreñimiento, fiebre, diarrea y a la palpación; masa abdominal. La duración de los síntomas es mayor a dos semanas. El laboratorio a veces es normal con aumento del VES. El contraste baritado muestra la pared del colon de aspecto irregular sin lesiones intraluminales. La ecografía; masa hiperecogenica bien definida en la raíz. La TAC: aumento de la densidad grasa, del mesenterio, bien delimitada con halo graso o pseudocapsula que rodea a los ganglios y vasos (signo del anillo graso fat-ring sign).

The present study aims to display how the patient symptomatology does not help to determine a clear presuntive diagnoses, especially when we deal with primary mesenteric masses that can simulate a biliary pathology, mesenteric vascular disorder, right lower quadrant syndrome and dependent gynecological pathologies of right annex. CT is a diagnostic pattern that second level hospitals do not have, so that decisions are taken into the emergency room. An exploratory laparatomy is the option to face up such acute abdomen in order to avoid complications in organs of abdominal cavity as well as legal problems. This case report, surgery results displayed the presence of a mesenteric mass corresponding to a non-specific mesenteric abscess compatible with a intra-abdominal panniculitis, an unusual pathology according to national and international statistics data. The most frecuent symptoms are abdominal pain, anorexia, abdominal fullness, loss of weight and sometimes intestinal occlusion. Constipation, fever, diarrhea and abdominal tenderness are additional manifestations. Those symptoms last longer than two weeks. Laboratory results display normal but with an increased ESR. Barium test shows a colon wall of irregular appearance without intraluminal injury. Ultrasound shows a hyperechoic mass well defined in the root. CT reflects an increased density of the mesenteric fat, well defined with a pseudocapsule that rounds lymph nodes and vessels (fat-ring sign).

Paniculitis mesentérica asociada a enfermedad relacionada con IgG4 como causa de fiebre de origen desconocido / Mesenteric panniculitis associated with IgG4-related disease as a cause of fever of unknown origin

La paniculitis mesentérica es un raro desorden inflamatorio de la grasa mesentérica, de la cual hay, hasta ahora, aproximadamente 200 casos reportados en la literatura. Se presenta en adultos a partir de la tercera década de la vida y su etiología es desconocida, pero es sabida su asociación con neoplasias gastrointestinales, genitourinarias y enfermedades reumatológicas. Entre sus manifestaciones clínicas están el dolor abdominal, las alteraciones del tránsito intestinal, la pérdida de peso, la fiebre y los vómitos. El diagnóstico definitivo es fundamentalmente histopatológico, también existen algunos estigmas tomográficos que podrían sugerir su presencia. Debe ser tratada a la mayor brevedad posible y los corticosteroides son los medicamentos a elegir. Se presentó un paciente con diagnóstico de paniculitis mesentérica idiopática, como resultado del estudio de una fiebre de origen desconocido, en el cual logramos además demostrar la asociación de la paniculitis con la enfermedad relacionada con IgG4, desorden recientemente descubierto, caracterizado por lesiones inflamatorias seudotumorales, que cursan con infiltración hística por células plasmáticas IgG4 positivas.

Mesenteric panniculitis is a rare inflammatory disorder of the mesenteric fat, of which there is, so far, about 200 cases reported in the literature. It occurs in elderly adults and its etiology is unknown but its association with gastrointestinal tumors, genitourinary and rheumatological diseases is known. Among its clinical manifestations are abdominal pain, altered bowel movements, weight loss, fever and vomiting. The definitive histopathological diagnosis is fundamentally, there is some tomographic stigma that might suggest its presence. It should be treated as soon as possible and corticosteroids are the drugs of choice. A patient diagnosed with idiopathic mesenteric panniculitis as a result of the evaluation of fever of unknown origin, which we further demonstrate the association of panniculitis with related disease IgG4, disorder recently discovered, characterized by lesions in flammatory pseudotumoral occurs, that occur with tissue infiltration IgG4 positive plasma cells.

Paniculitis mesentérica como causa poco frecuente de dolor abdominal agudo / Mesenteric panniculitis as a rare cause of acute abdominal pain

La paniculitis mesentérica es un proceso inflamatorio poco habitual que afecta al tejido graso del mesenterio y, con menor frecuencia, al mesocolon o al retroperitoneo. Puede cursar con dolor abdominal, diarrea, pérdida de peso o masa palpable, y rara vez se presenta con un cuadro de dolor abdominal agudo. En la mayoría de los casos es asintomática. La etiología es desconocida, aunque se han descrito como posibles agentes causales la isquemia, la infección, el traumatismo abdominal, los antecedentes quirúrgicos y los procesos autoinmunes. También se ha planteado su asociación con determinados fármacos, procesos inflamatorios idiopáticos y neoplasias. La tomografía computada (TC) es la técnica de imagen de elección para su diagnóstico y los hallazgos pueden variar desde el incremento de la atenuación en el mesenterio hasta la presencia de una masa sólida en relación con el componente tisular predominante (grasa, tejido inflamatorio o fibrosis). Presentamos 3 pacientes que acudieron al Servicio de Urgencias con dolor abdominal agudo y cuyo diagnóstico final fue paniculitis mesentérica como causa del cuadro.

Mesenteric panniculitis is an unusual inflammatory disorder involving the adipose tissue of the mesentery and, less frequently, the mesocolon and the retroperitoneum. Patients may present with abdominal pain, diarrhea, weight loss or abdominal mass, and only rarely with symptoms of acute abdominal pain. In most cases, it is asymptomatic. Although the etiology of mesenteric panniculitis is unknown, ischemia, infection, abdominal trauma, previous abdominal surgery, and autoimmune disorders have been reported as possible causative agents. It has also been suggested its association with certain drugs, idiopathic inflammatory processes, and malignancy.Computed tomography (CT) is the gold standard imaging technique for its diagnosis; computed tomography findings may vary from increased attenuation of the mesentery to a solid soft-tissue mass depending on the predominant tissue component (fat, inflammation or fibrosis). We report 3 cases of patients who presented at the Emergency Department with acute abdominal pain and were diagnosed with mesenteric panniculitis.

Paniculite mesentérica pseudotumoral: aspectos tomográficos de um caso / Pseudotumoral mesenteric panniculitis: tomographic findings in a case

A paniculite mesentérica representa um processo inflamatório do mesentério de ocorrência rara e etiologia desconhecida, que apenas em alguns poucos casos pode se manifestar sob a forma de pseudotumores abdominais. Descreve-se, enfatizando os aspectos tomográficos, um raro caso de paniculite mesentérica que se apresentou inicialmente como um pseudotumor que envolvia a região peripancreática.

Mesenteric panniculitis is a rare inflammatory process of the mesentery whose etiology is unknown that in only very few cases may present as an abdominal pseudotumor. The authors report a rare case, emphasizing the tomographic findings of mesenteric panniculitis that initially presented as a pseudotumor involving the peripancreatic region.

Paniculitis mesentérica: ¿predictor de una neoplasia? / Mesenteric panniculitis: predictor of a neoplasm

Introduction: Mesenteric panniculitis is a rare disorder characterized by chronic, non-specific inflammation involving the adipose tissue of the bowel mesentery of unknown aetiology. It has been associated with different processes, including digestive and urothelial malignancies. Case report: A 44-years-old man carne to the Emergency Department complaining of mesogastric pain for the last 24 hours. CT sean showed an increased density of the mesenteric adipoid tissue. Mesenteric paniculitis was diagnosed and antibiotic treatment was instaured. The patient recovered uneventfully. Two months later the patient was diagnosed of an infiltrating urothelial carcinoma. Conclusions: Mesenteric panniculitis may be associated with malignancies and other pathologies. It is advisable to perform tests to dismiss the coexistence of these disorders. In those cases, in which associated diseases could not be demonstrated, a frequent follow-up would be advisable to achieve an early diagnosis if these appear.

Introducción: La paniculitis mesentérica es un trastorno poco frecuente caracterizado por inflamación crónica inespecífica del tejido adiposo del mesenterio intestinal de etiología desconocida. Se ha relacionado con diversas patologías, entre ellas neoplasias digestivas y uroteliales. Caso clínico: Varón de 44 años que acude a Urgencias por un dolor mesogástrico de 24 horas de evolución. En la TC abdominal se objetivó un aumento de densidad de la grasa de la raíz del mesenterio. Se diagnosticó de paniculitis mesentérica y se trató mediante antibioterapia. A los 2 meses el paciente es diagnosticado de un carcinoma urotelial infiltrante. Discusión: La paniculitis mesentérica puede estar relacionada con neoplasias y otras patologías. Es conveniente realizar pruebas para descartar la coexistencia de alguna de las enfermedades asociadas. En aquellos casos en los que no se demuestre, sería recomendable un seguimiento periódico.

Paniculite mesentérica (PM) e fibromatose mesentérica (FM): relato de casos / Mesenteric panniculitis (MP) and mesenteric fibromatosis (MF): report of cases

A paniculite mesentérica (PM) e a fibromatose mesentérica (FM) são doenças fibróticas de etiologia incerta. São mais frequentes no mesentério do intestino delgado, no grande omento e nos mesocólons. Clinicamente a FM pode apresentar-se de forma aguda na qual uma complicação da doença é sua primeira expressão. Na forma crônica é caracterizada por sintomas abdominais vagos e/ou massa abdominal palpável. A comprovação diagnóstica, assim como na PM, é feita através de laparotomia exploradora ou videolaparoscopia diagnóstica e biopsia. Os autores relatam dois casos sendo um de PM e outro de FM, apresentam um paralelo dos aspectos clínicos, tomográficos, diagnóstico, histopatológico e terapêutico destacando as semelhanças e as diferenças entre essas duas patologias.

Mesenteric panniculitis (MP) and mesenteric fibromatosis (MF) are fibrotic diseases of uncertain aetiology. Both occur most frequently in the mesentery of the small intestine, the greater omentum and the mesocolons. In its acute form, the first clinical symptoms of MF are complications of the disease. Chronic MF is characterized by vague abdominal symptoms and/or a palpable abdominal mass. Like mesenteric panniculitis, mesenteric fibromatosis can be diagnostically verified by exploratory laparotomy, or diagnostic video-laparoscopy and biopsy. Here, we present two cases, one of MP and the other of MF, with resembling clinical and tomographic aspects, as well as similarities in diagnosis, histopathology and therapy. With our case report, we want to emphasise both similarities and differences between these two pathologies.

Paniculitis mesentérica asociada con absceso intraabdominal / Mesenteric panniculitis with intraabdominal abcess: report of one case

La paniculitis mesentérica es una enfermedad inflamatoria del tejido adiposo del mesenterio, de presentación infrecuente y que se caracteriza, por el engrasamiento, endurecimiento y nodularidad del mismo. Se pone en consideración un caso clínico en un varón joven, con una forma de presentación poco común que requirió de laparotomía exploradora para realizar el diagnóstico y tratamiento.

We report a 28 years old obese male presenting with abdominal pain of increasing intensity lasting 15 days. In the last days, diarrhea and fever appeared. On abdominal examination a 8 cm painful mass was palpated. An abdominal ultrasound showed an anechoic mass in the epigastrium. An abdominal CAT sean showed an inflammatory mass that involves the small bowel. The patient is subjected to a percutaneous needle aspiration, obtaining 50 mi of a purulent fluid. Due to persistence of fever, the patient was operated finding an inflammation that involved the mesentery and the great omentum and covering abscess. The pathologic study of the surgical piece reported a unspecific nodular mesenteric panniculitis.