From the Research
Mesenteric panniculitis is a rare, benign, and idiopathic disorder characterized by chronic inflammation of the mesenteric adipose tissue of the small intestine, with treatment typically involving addressing symptoms and reducing inflammation, and for symptomatic patients, corticosteroids like prednisone are often the first-line treatment. The condition is often asymptomatic, but when symptoms occur, they can include abdominal pain, nausea, and weight loss, and diagnosis relies on a combination of imaging findings, particularly the characteristic "misty mesentery" appearance on CT scan, and when indicated, histological confirmation 1. The exact etiology of mesenteric panniculitis remains unknown, but theories include autoimmune processes, previous abdominal surgery, or vascular insufficiency triggering inflammation in the mesenteric fat 2. Some key points to consider in the management of mesenteric panniculitis include:
- For mild cases, observation may be sufficient, but for symptomatic patients, corticosteroids like prednisone (starting at 40mg daily with gradual tapering over 3-6 months) are often the first-line treatment 3.
- Immunosuppressants such as azathioprine, cyclophosphamide, or methotrexate may be added for steroid-resistant cases 4.
- Tamoxifen has shown effectiveness in some patients due to its anti-fibrotic properties 2.
- NSAIDs like ibuprofen can help manage pain and inflammation, and for severe abdominal pain, opioid analgesics might be necessary short-term 5.
- Nutritional support is important, with small, frequent, low-fat meals recommended, and regular follow-up with abdominal imaging every 6-12 months is advised to monitor disease progression 3.
- Surgery is generally avoided unless complications like bowel obstruction occur 5. Overall, the goal of treatment is to reduce symptoms and prevent complications, while also monitoring for any changes in the condition that may require adjustments to the treatment plan 1.