What is the treatment for mesenteric panniculitis?

Treatment of Mesenteric Panniculitis

Corticosteroids are the first-line treatment for symptomatic mesenteric panniculitis, with prednisone 40 mg daily showing good clinical and radiological responses in most patients. 1, 2

Understanding Mesenteric Panniculitis

Mesenteric panniculitis is a rare, benign, chronic inflammatory condition affecting the adipose tissue of the mesentery, primarily in the small bowel. It is characterized by:

• Fibrosis and chronic inflammation of mesenteric fatty tissue
• Typically diagnosed via CT scan with IV contrast
• May require biopsy in equivocal cases

Treatment Algorithm

First-Line Treatment

• Corticosteroids:
  • Oral prednisone 40 mg daily 1, 2
  • Continue until clinical improvement (typically within 1 month)
  • Gradually taper once symptoms resolve

Second-Line/Alternative Treatments

• Immunosuppressive agents:
  • Azathioprine (when steroid-sparing strategy is needed) 2, 3
  • Thalidomide (has been prospectively evaluated) 3
  • Low-dose naltrexone (has been prospectively evaluated) 3

Combination Therapy

• For refractory cases, combination therapy may be considered:
  • Prednisone + azathioprine 2
  • Prednisone + colchicine 2

Monitoring Treatment Response

• Clinical symptom assessment (abdominal pain, fever, weight changes)
• Follow-up CT imaging to evaluate radiological improvement
• Regular laboratory tests to monitor for medication side effects

Special Considerations

Surgical Management

• Surgery is generally not curative and should be avoided 3
• Surgical intervention should be limited to:
  • Obtaining diagnostic tissue samples when diagnosis is uncertain
  • Managing complications such as bowel obstruction due to fibrosis
  • Cases that fail to respond to medical therapy 2

Disease Course and Prognosis

• Overall prognosis is generally good 1
• Most patients respond well to medical therapy
• Recurrence appears to be rare after successful treatment 1
• Some cases may resolve spontaneously, while others may require prolonged treatment 3

Potential Pitfalls

• Delaying treatment in symptomatic patients can lead to prolonged morbidity
• Failure to rule out malignancy or other conditions that may mimic mesenteric panniculitis
• Prolonged steroid use without appropriate monitoring for side effects
• Inadequate follow-up to assess treatment response

While there are no formal guidelines specifically addressing mesenteric panniculitis treatment, the evidence consistently supports corticosteroids as effective first-line therapy, with immunomodulatory agents as alternatives or adjuncts for refractory cases.