RESUMEN
Fat necrosis occurs more frequently in patients who have obesity and diabetes mellitus and is linked to worsening of diabetes. Little evidence is available about surgical complications that are related to inflammation and necrosis of adipose tissue. We report two cases of young women with diabetes who underwent bariatric surgery and had complications resulting from extensive inflammation and necrosis of adipose tissue. The first patient was diagnosed with omental infarction, which is a type of fat necrosis that is rarely associated with obesity and bariatric surgery. The second patient had an intraoperative finding of mesenteric panniculitis, which resulted in an intra-operative change in the choice of bariatric surgery to do a sleeve gastrectomy instead of a gastric bypass. Surgeons who perform surgery on bariatric patients must be aware of complications related to excessive amount of adipose tissue.
Asunto(s)
Cirugía Bariátrica/efectos adversos , Infarto/diagnóstico , Obesidad Mórbida/cirugía , Epiplón/irrigación sanguínea , Paniculitis Peritoneal/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adulto , Cirugía Bariátrica/métodos , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Infarto/etiología , Periodo Intraoperatorio , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Paniculitis Peritoneal/etiología , Complicaciones Posoperatorias/etiologíaRESUMEN
Background/aim: Mesenteric panniculitis (MP) is an idiopathic benign disease characterized by fat necrosis, chronic inflammation, and fibrosis. The relationship between obesity and chronic low-grade inflammation has been reported. This study investigated the relationship of MP diagnosed using multidetector computed tomography (MDCT) with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. Materials and methods: We retrospectively enrolled 104 patients with no radiological findings other than MP. Additionally, 76 individuals without any indicative radiological findings were included as controls. VAT and SAT were separately calculated (cm2) using a 3-dimensional workstation. The abdominal circumference was measured (cm). Results: The mean abdominal circumference was 99.9 ± 7.9 cm, SAT was 195.3 ± 89.1 cm2, and VAT was 203.9 ± 72.8 cm2 in the MP group. The abdominal circumference, VAT, and SAT were significantly higher in the MP group than in the control group (P < 0.001). According to the receiver operating characteristic (ROC) analysis, cut-off level VAT and SAT were 167.5 cm2 (sensitivity 71%, specificity 69%) and 117.5 cm2 (sensitivity 78%, specificity 51 %), respectively. Conclusion: Increased VAT and SAT were associated with MP, suggesting their role in the etiology of MP.
Asunto(s)
Grasa Intraabdominal/fisiología , Paniculitis Peritoneal/etiología , Grasa Subcutánea/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Humanos , Grasa Intraabdominal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector , Paniculitis Peritoneal/diagnóstico por imagen , Estudios Retrospectivos , Grasa Subcutánea/diagnóstico por imagenAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones por Mycobacterium/complicaciones , Mycobacterium/aislamiento & purificación , Paniculitis Peritoneal/etiología , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Adulto , Resultado Fatal , Infecciones por VIH/microbiología , Humanos , Huésped Inmunocomprometido , Masculino , Infecciones por Mycobacterium/patología , Paniculitis Peritoneal/patología , Tomografía Computarizada por Rayos XRESUMEN
Mesenteric panniculitis is an uncommon pathology, of poorly understood etiology, characterized by progressive inflammation and fibrosis of the small bowel mesentery. This disease has been reported usually after other abdominal surgeries. We present two cases of young male patients who underwent laparoscopic sleeve gastrectomy and developed abdominal symptoms within 45-60 days of surgery. Both were investigated for known post-bariatric complications. While first patient presented (5 months later) at an irreversible stage and died within 8-9 months of primary surgery, in second patient, the disease process could be reversed through early intervention, diagnosis, treatment, and compliance. Mesenteric panniculitis is a rapidly progressive entity, which can be adequately treated by early identification and long-term immune-suppressive therapy.
Asunto(s)
Cirugía Bariátrica/efectos adversos , Mesenterio/patología , Obesidad Mórbida/cirugía , Paniculitis Peritoneal/etiología , Paniculitis Peritoneal/patología , Adulto , Humanos , Masculino , Obesidad Mórbida/patologíaAsunto(s)
Síndromes Mielodisplásicos/complicaciones , Paniculitis Peritoneal/etiología , Azacitidina/uso terapéutico , Médula Ósea/patología , Terapia Combinada , Trasplante de Células Madre de Sangre del Cordón Umbilical , Transfusión de Eritrocitos , Femenino , Humanos , Hiperplasia , Persona de Mediana Edad , Síndromes Mielodisplásicos/tratamiento farmacológico , Síndromes Mielodisplásicos/terapia , Paniculitis Peritoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
IgG4-related disease (IgG4-RD) is a rare form of autoimmune sclerosing disease, characterised by elevated serum IgG4 and tissue IgG4 levels, specific histopathological findings, multiorgan involvement and adequate response to glucocorticoid treatment. The low incidence and the heterogeneous nature of the disease has made consensus on diagnostic criteria for IgG4-RD difficult. Whether sclerosing mesenteritis (SM) is considered a manifestation of IgG4-RD is strongly debated. We present the case of a patient with a history of rheumatoid arthritis who presented with a calcified abdominal mass. She was found to have an isolated, pedunculated mesenteric mass positive for IgG4 and concurrently elevated serum IgG4 levels. Clinical features did not classify her disease as either SM or IgG4-RD as currently described in consensus statements. Concurrent diagnoses of IgG4-RD, SM and other autoimmune disorders, as well as postoperative recommendations for resected isolated IgG4-positive masses, are discussed.
Asunto(s)
Enfermedades Autoinmunes/inmunología , Inmunoglobulina G/sangre , Mesenterio/patología , Paniculitis Peritoneal/diagnóstico por imagen , Enfermedades de los Anexos/diagnóstico por imagen , Enfermedades de los Anexos/patología , Enfermedades Autoinmunes/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Hallazgos Incidentales , Laparoscopía/métodos , Mesenterio/cirugía , Persona de Mediana Edad , Paniculitis Peritoneal/etiología , Paniculitis Peritoneal/inmunología , Paniculitis Peritoneal/patología , Células Plasmáticas/patología , Enfermedades Raras , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
Mesenteric panniculitis is a nonspecific inflammation involving the mesentery. Its clinical presentation is variable depending on the stage of the disease. Clinical signs are usually pain but half of the patients remain asymptomatic. Palpable abdominal mass, weight loss, nausea and vomiting. There may be an inflammatory syndrome of variable intensity. Panniculitis is suspected based on scan showing hyperdense mesentery with adhesions to adjacent organs. Histologically there is adipocyte degeneration causing foreign body reaction and appear lymphoplasmacytic inflammatory lesions. We report a new case of mesenteric panniculitis associated with acute pancreatitis.
Asunto(s)
Dolor Abdominal/etiología , Pancreatitis/complicaciones , Paniculitis Peritoneal/etiología , Enfermedad Aguda , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico , Pancreatitis/patología , Paniculitis Peritoneal/diagnóstico , Paniculitis Peritoneal/patologíaRESUMEN
La paniculitis mesentérica es una entidad caracterizada por inflamación crónica e inespecífica del mesenterio. Existe poca información y a menudo confusa sobre sus características, así como sobre la actitud a seguir una vez que se evidencia en una prueba de imagen. Nos proponemos describir las características epidemiológicas, clínicas, analíticas, radiológicas y patológicas de los pacientes con paniculitis mesentérica publicados en la literatura, así como las entidades posiblemente causales o asociadas a la paniculitis mesentérica, según la opinión de los autores de cada estudio. Por último, revisaremos las diferentes opciones terapéuticas utilizadas y la respuesta a las mismas. Para ello se realizó una búsqueda bibliográfica en las principales bases de datos médicas, seleccionando aquellos artículos con información sobre estos aspectos, recogiendo dicha información en una base de datos que se almacenó en el paquete estadístico SPSS para su posterior análisis y resumen (AU)
Mesenteric panniculitis is a condition characterized by chronic nonspecific inflammation of the mesentery. There is little and often confusing information about its characteristics and the approach to take once it has been demonstrated by an imaging test. We propose to describe the epidemiological, clinical, laboratory, radiological and pathological features of the patients with mesenteric panniculitis reported in the literature, as well as possible disorders causal or associated with mesenteric panniculitis, in the opinion of the authors of each study. Finally, we will review the different therapeutic options used and the response to them. To that end a literature search was performed from the main medical databases selecting ítems with information on these aspects. This information was collected on a database stored in SPSS software for further analysis and summary (AU)
Asunto(s)
Humanos , Masculino , Femenino , Paniculitis Peritoneal/epidemiología , Paniculitis Peritoneal/patología , Paniculitis Peritoneal/etiología , Mesenterio/patología , Mesenterio , Mesenterio/cirugía , Necrosis Grasa/diagnóstico , Necrosis Grasa/patología , Necrosis Grasa , Fibrosis/diagnóstico , Fibrosis/patología , Fibrosis , Prevalencia , Incidencia , Glucocorticoides/administración & dosificación , Glucocorticoides/farmacología , Glucocorticoides/uso terapéutico , Progresión de la Enfermedad , Diagnóstico por Imagen/instrumentación , Diagnóstico por Imagen/métodos , Diagnóstico por ImagenRESUMEN
Mesenteric panniculitis is a condition characterized by chronic nonspecific inflammation of the mesentery. There is little and often confusing information about its characteristics and the approach to take once it has been demonstrated by an imaging test. We propose to describe the epidemiological, clinical, laboratory, radiological and pathological features of the patients with mesenteric panniculitis reported in the literature, as well as possible disorders causal or associated with mesenteric panniculitis, in the opinion of the authors of each study. Finally, we will review the different therapeutic options used and the response to them. To that end a literature search was performed from the main medical databases selecting ítems with information on these aspects. This information was collected on a database stored in SPSS software for further analysis and summary.
Asunto(s)
Paniculitis Peritoneal , Salud Global , Humanos , Paniculitis Peritoneal/diagnóstico , Paniculitis Peritoneal/epidemiología , Paniculitis Peritoneal/etiología , Paniculitis Peritoneal/terapia , Prevalencia , Factores de RiesgoRESUMEN
A 62-year-old man was diagnosed with a moderately differentiated gastric adenocarcinoma in the proximal stomach. A staging 18F-FDG PET/CT showed an intensely FDG-avid gastric mass, as well as a mildly FDG-avid misty nodular mesentery. After 3 cycles of neoadjuvant chemotherapy, a follow-up PET/CT showed partial response of the gastric primary, with increase in the size of nodules in the mesentery and increased FDG uptake, raising concern of secondary malignancy. Biopsy of the mesentery revealed xanthogranulomatous inflammation, consistent with sclerosing mesenteritis.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Imagen Multimodal , Paniculitis Peritoneal/diagnóstico por imagen , Tomografía de Emisión de Positrones , Neoplasias Gástricas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma/tratamiento farmacológico , Diagnóstico Diferencial , Reacciones Falso Positivas , Fluorodesoxiglucosa F18 , Humanos , Masculino , Mesenterio/diagnóstico por imagen , Persona de Mediana Edad , Terapia Neoadyuvante/efectos adversos , Paniculitis Peritoneal/etiología , Radiofármacos , Neoplasias Gástricas/tratamiento farmacológicoAsunto(s)
Colonoscopía/efectos adversos , Mesenterio , Paniculitis Peritoneal/etiología , Anciano , Femenino , HumanosAsunto(s)
Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Mesenterio , Paniculitis Peritoneal , Anciano , Enfermedades Asintomáticas , Biopsia , Diagnóstico Diferencial , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Mesenterio/diagnóstico por imagen , Mesenterio/patología , Paniculitis Peritoneal/diagnóstico , Paniculitis Peritoneal/etiología , Paniculitis Peritoneal/fisiopatología , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Mesenteric panniculitis is an uncommon clinical entity which sometimes may be associated with hematologic, gastrointestinal and urological neoplasms. The diagnostic procedure ofchoice is based on obtaining a tissue sample for histopathological study usually through apercutaneous procedure. Treatment is indicated in symptomatic cases.
Asunto(s)
Linfoma de Células B/complicaciones , Paniculitis Peritoneal/etiología , Anciano , Humanos , MasculinoRESUMEN
Guanylin (Gn), a bioactive peptide, and its receptor, guanylyl cyclase-C (GC-C), are primarily present in the intestine and maintain homeostasis in body fluids. Recently, rats whose macrophages overexpress Gn and GC-C were found to be resistant to diet-induced obesity. Considering that obesity is strongly related to a chronic inflammatory state in white adipose tissues, it is possible that Gn-GC-C macrophages contribute to the regulation of inflammation. In the present study, we investigated the inflammatory state of mesenteric fat in rats transgenic for both Gn and GC-C (double-transgenic [dTg] rats) by evaluating the levels of cyclic guanosine monophosphate (cGMP), a second messenger of Gn-GC-C, cGMP-dependent protein kinase (PKG), and phosphorylated vasodilator-stimulated phosphoprotein (VASP), a target protein of PKG. The levels of cGMP in dTg rats was higher than in WT rats fed the same diet. Although there were no significant differences in levels of PKG and phosphorylated VASP between WT and dTg rats fed a standard diet (STD), these levels in dTg rats fed a high fat diet (HFD) were markedly increased compared with levels in HFD WT rats. Furthermore, mRNA levels of proinflammatory factors in mesenteric fat were lower in HFD dTg rats than in HFD WT rats and were similar to levels in STD WT and dTg rats. These results indicate that the Gn-GC-C system in macrophages regulates the cGMP-PKG-VASP pathway and controls obesity through the downregulation of proinflammatory factors.
Asunto(s)
GMP Cíclico/metabolismo , Hormonas Gastrointestinales/metabolismo , Grasa Intraabdominal/metabolismo , Macrófagos Peritoneales/metabolismo , Péptidos Natriuréticos/metabolismo , Paniculitis Peritoneal/metabolismo , Receptores Acoplados a la Guanilato-Ciclasa/agonistas , Receptores de Péptidos/agonistas , Sistemas de Mensajero Secundario , Animales , Moléculas de Adhesión Celular/metabolismo , Proteínas Quinasas Dependientes de GMP Cíclico/metabolismo , Dieta Alta en Grasa/efectos adversos , Hormonas Gastrointestinales/genética , Inmunohistoquímica , Mediadores de Inflamación/metabolismo , Grasa Intraabdominal/enzimología , Grasa Intraabdominal/inmunología , Grasa Intraabdominal/patología , Macrófagos Peritoneales/enzimología , Macrófagos Peritoneales/inmunología , Macrófagos Peritoneales/patología , Masculino , Proteínas de Microfilamentos/metabolismo , Péptidos Natriuréticos/genética , Obesidad/etiología , Obesidad/inmunología , Obesidad/metabolismo , Obesidad/patología , Paniculitis Peritoneal/etiología , Paniculitis Peritoneal/inmunología , Paniculitis Peritoneal/patología , Fosfoproteínas/metabolismo , Fosforilación , Procesamiento Proteico-Postraduccional , Distribución Aleatoria , Ratas , Ratas Transgénicas , Receptores de Enterotoxina , Receptores Acoplados a la Guanilato-Ciclasa/genética , Receptores Acoplados a la Guanilato-Ciclasa/metabolismo , Receptores de Péptidos/genética , Receptores de Péptidos/metabolismoRESUMEN
BACKGROUND: Fibromuscular dysplasia (FMD) is a nonatheromatous, noninflammatory arterial disorder of unknown etiology resulting in vessel stenosis and/or aneurysm formation. The renal and cephalocervical (mainly carotid arteries) arterial beds are classically involved; involvement of visceral arteries is rare. Mesenteric panniculitis (MP) is an inflammatory process of mesenteric fat considered to be of unknown etiology. The majority of cases involve the small bowel mesentery; colorectal MP is rare. To our knowledge, no example of MP due to FMD has been described. CASE PRESENTATION: A 52 year old man presented with steadily worsening lower abdominal pain. Investigation revealed ischemic rectosigmoid mucosa associated with a large mesenteric mass of unknown nature. Angiography showed the disease was limited to the distribution of the inferior mesenteric artery. Subsequent symptoms of large bowel obstruction necessitated a left hemicolectomy. Pathologic examination showed bowel wall necrosis and massive panniculitis of the rectosigmoid due to FMD. Subsequent angiographic imaging of other vascular beds was negative. CONCLUSIONS: Several features of this case are noteworthy: FMD limited to the inferior mesenteric artery has not been previously reported, FMD has not previously been implicated as a cause of MP, and the massive extent of panniculitis. An accompanying literature review of cases of visceral FMD, traditionally believed to almost exclusively affect females, highlights a greater than anticipated number of males (33%), and a gender difference regarding concomitant involvement of cephalocervical and/or renal vascular beds (32% in males versus 80% in females). The latter observation may have implications regarding the value of radiologic screening of other vascular beds, particularly in asymptomatic males, in patients presenting with visceral artery FMD.
Asunto(s)
Displasia Fibromuscular/diagnóstico , Arteria Mesentérica Inferior , Paniculitis Peritoneal/etiología , Displasia Fibromuscular/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Paniculitis Peritoneal/diagnósticoRESUMEN
The impact of an increase in maternal fat consumption on fetal metabolic programming separately from maternal obesity remains unclear. The purpose of this study was to document the effect of in utero high-fat diet exposure on the development of metabolic syndrome characteristics in offspring. C57BL/6 female mice were fed either a control diet (10% fat) or a moderately high-fat (MHF) diet (45% fat) until delivery. All pups were fostered to mothers fed with the control diet. Pups were raised on the control diet and assessed until 35 weeks of age. The caloric intake from fat was significantly increased in the MHF dams compared with the control dams. There were no significant differences in the maternal weight at mating or at gestational Day 18 between the two groups. The MHF offspring did not become obese, but they developed hypertension and glucose intolerance. Moreover, the MHF offspring had significantly higher serum non-esterified fatty acid and triglyceride levels during the refeeding state following fasting as compared with the control offspring. Serum adiponectin levels were significantly lower, and the cell size of the mesenteric adipose tissue was significantly larger in the MHF offspring than in the control offspring. The mRNA levels of the proinflammatory macrophage markers in the mesenteric adipose tissue were significantly higher in the MHF offspring than those of the control offspring. These results suggest that in utero high-fat diet exposure causes hypertension and glucose intolerance resulting from mesenteric adipose tissue dysfunction in offspring, independently of maternal obesity.
Asunto(s)
Dieta Alta en Grasa/efectos adversos , Desarrollo Fetal , Grasa Intraabdominal/inmunología , Fenómenos Fisiologicos Nutricionales Maternos , Síndrome Metabólico/etiología , Paniculitis Peritoneal/etiología , Adiponectina/sangre , Animales , Biomarcadores/sangre , Biomarcadores/metabolismo , Tamaño de la Célula , Ácidos Grasos no Esterificados , Femenino , Intolerancia a la Glucosa/etiología , Hiperlipidemias/etiología , Hipertensión/etiología , Grasa Intraabdominal/patología , Activación de Macrófagos , Masculino , Síndrome Metabólico/congénito , Síndrome Metabólico/inmunología , Síndrome Metabólico/fisiopatología , Ratones Endogámicos C57BL , Paniculitis Peritoneal/sangre , Paniculitis Peritoneal/congénito , Paniculitis Peritoneal/inmunología , Embarazo , Triglicéridos/sangreRESUMEN
Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.
Asunto(s)
Enfermedad de Crohn/diagnóstico , Inmunoglobulina G/sangre , Paniculitis Peritoneal/diagnóstico , Antiinflamatorios/uso terapéutico , Apéndice/patología , Azatioprina/uso terapéutico , Colonoscopía , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Imagen por Resonancia Magnética , Mesalamina/uso terapéutico , Persona de Mediana Edad , Paniculitis Peritoneal/diagnóstico por imagen , Paniculitis Peritoneal/etiología , Prednisolona/uso terapéutico , Tomografía Computarizada por Rayos X , Ultrasonografía , Vejiga Urinaria/patologíaRESUMEN
Abdominal mesenteritis is a rare and poorly understood gastroenterological disease. Here, we report on two identical cases of Mycobacterium genavense associated retractile mesenteritis in HIV-positive patients. A literature search retrieved only few small retrospective studies, which characterize the clinical course of this seldom infection. We propose a pathogen-specific syndrome of retractile mesenteritis in HIV-positive patients linked to Mycobacterium genavense infection on the basis of our clinical observation and literature meta-analysis with duodenal wall thickening, central mesenterial mass and vascular complications.