From the Research
Mesenteric panniculitis is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery, and its treatment should be guided by the severity of symptoms and presence of complications, with first-line medical treatment being prednisone and tamoxifen 1.
Definition and Diagnosis
Mesenteric panniculitis (MP) is a rare inflammatory condition affecting the fatty tissue of the mesentery, which is the membrane that attaches the intestines to the abdominal wall. The diagnosis is suggested by computed tomography (CT) scan and is usually confirmed by surgical biopsies if necessary.
- The condition 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.
Treatment
Treatment typically involves addressing symptoms and reducing inflammation.
- For mild cases, observation may be sufficient, but for symptomatic patients, corticosteroids like prednisone (starting at 40mg daily with gradual tapering over several weeks) are often the first-line treatment, as supported by a recent study 1.
- Immunosuppressive medications such as azathioprine, cyclophosphamide, or tamoxifen may be added for steroid-resistant cases.
- NSAIDs like ibuprofen can help manage pain and inflammation.
- Surgery is reserved for cases of recurrent bowel obstruction or when the diagnosis is unclear, or in the case of severe presentation such as mass effect, bowel obstruction, or ischemic changes 2.
Prognosis and Complications
The condition often resolves spontaneously, but some cases may become chronic, requiring long-term management.
- The exact cause remains unknown, but theories include autoimmune processes, previous abdominal surgery, or local inflammatory responses.
- Complications can include bowel obstruction or vascular compromise, so prompt medical attention for worsening symptoms is essential, as highlighted in a recent case report 3.
- Early recognition and appropriate management of mesenteric panniculitis are essential for optimal outcomes, and thorough evaluation is necessary to exclude underlying malignancy and prevent complications 3.