From the Research
Messenteric panniculitis should be treated with prednisone and tamoxifen as first-line medical treatment, with surgery reserved for cases of recurrent bowel obstruction, as this approach prioritizes reducing symptoms and preventing complications, thereby improving morbidity, mortality, and quality of life 1.
Overview of Messenteric Panniculitis
Messenteric panniculitis is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery. It 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.
Diagnosis and Treatment
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.
- The condition often results from an abnormal immune response causing inflammation and fibrosis in the mesenteric fat.
- While some cases resolve spontaneously, others may progress to fibrosis, potentially causing bowel obstruction or other complications.
- First-line treatment typically involves corticosteroids like prednisone, with immunosuppressive medications such as tamoxifen added for steroid-resistant cases 1.
- Pain management with NSAIDs or, if necessary, opioid analgesics may be required.
- Patients should receive regular follow-up care with abdominal imaging to monitor disease progression.
Key Considerations
- 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 2.
- 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.