Causes of Mesenteric Panniculitis
Mesenteric panniculitis is a chronic inflammatory condition of the mesenteric adipose tissue with an unknown primary etiology, but multiple associated triggers and conditions have been identified, including abdominal trauma, prior surgery, autoimmune diseases, malignancy, and infection. 1, 2
Primary Etiological Considerations
The fundamental cause of mesenteric panniculitis remains unclear, but it is postulated to be an immune-mediated chronic inflammatory process and/or a paraneoplastic phenomenon. 2 The disease represents a continuum of inflammatory changes characterized by focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. 2
Identified Triggering Factors
Trauma and Surgical History
- Abdominal trauma is a major contributing factor to the development of mesenteric panniculitis 1, 2, 3
- Previous abdominal surgery has been consistently associated with disease onset 1, 2, 3
- These mechanical insults may act as triggers in genetically or immunologically predisposed individuals 2
Autoimmune Associations
- Personal or family history of autoimmune diseases is commonly present in patients with mesenteric panniculitis 2
- The condition may be complicated by autoimmune hemolytic anemia 4
- Patients often have concomitant autoimmune conditions, suggesting a shared immunologic pathway 2, 4
Malignancy
- Various cancers have been associated with mesenteric panniculitis, supporting a paraneoplastic mechanism 2, 3
- Angioimmunoblastic T-cell lymphoma has been reported as an underlying cause 4
- The relationship may be bidirectional, with some cases representing a paraneoplastic syndrome and others being coincidental 2, 3
Vascular and Inflammatory Mechanisms
- Inflammatory bowel disease may cause thrombosis around the superior mesenteric vein, potentially contributing to mesenteric inflammation 5
- Vascular compromise and subsequent fat necrosis may initiate the inflammatory cascade 5
Other Contributing Factors
- Infection has been identified as a possible trigger 2, 3
- Obesity has been associated with the condition 3
Important Clinical Caveats
Note that mesenteric panniculitis is distinct from mesenteric ischemia, which has different etiologies including arterial embolism, arterial thrombosis, and venous thrombosis. 6, 7 Do not confuse these entities—mesenteric panniculitis is a chronic inflammatory process of fat tissue, while mesenteric ischemia is an acute vascular emergency.
Also distinguish mesenteric panniculitis from alpha-1 antitrypsin deficiency-associated panniculitis, which affects subcutaneous tissue (typically thighs and buttocks) rather than mesenteric fat, and has a clear genetic etiology. 6
Pathophysiologic Spectrum
The disease exists on a spectrum from predominantly inflammatory forms (mesenteric panniculitis with inflammation and fat degeneration) to predominantly fibrotic forms (retractile panniculitis with retraction of surrounding structures). 3 The specific triggers may influence which end of this spectrum predominates in individual patients.