From the Guidelines
Mesenteric panniculitis should be managed with a focus on reducing inflammation and addressing symptoms, as there is no clear treatment recommendation available from controlled trials 1. When considering treatment options, it's essential to prioritize the patient's quality of life and minimize potential morbidity and mortality.
- Treatment may involve observation for mild cases, but for symptomatic patients, medications such as corticosteroids, immunosuppressive agents, NSAIDs, or colchicine may be considered.
- The use of corticosteroids, antibiotics, or cytostatic drugs has been reported as appearing useless in the management of panniculitis 1.
- Augmentation therapy with purified human AAT or fresh frozen plasma may be rational, safe, and effective in restoring plasma and local tissue levels of AAT, as seen in the context of alpha-1 antitrypsin deficiency 1.
- Dapsone, either alone or combined with augmentation therapy, may be of additional value, although its mechanism of action is unclear 1.
- A thorough evaluation is necessary to rule out underlying conditions that may be contributing to the development of mesenteric panniculitis, such as autoimmune processes, previous abdominal surgery, or underlying malignancy.
- Regular clinical assessments and occasional imaging should be used to monitor treatment response and adjust the treatment plan as needed.
From the Research
Definition and Characteristics of Mesenteric Panniculitis
- Mesenteric panniculitis (MP) is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery 2.
- It is a rare, slowly progressive, benign, and chronic fibrous inflammatory disease that affects the adipose tissue of the mesentery 3.
- The specific etiology of the disease is unknown, but it is influenced by many factors, mainly abdominal trauma and surgery 4.
Clinical Presentation
- MP is commonly detected incidentally on cross-sectional imaging of the abdomen and can be asymptomatic in up to nearly half of patients 2.
- The most frequent clinical symptom reported is abdominal pain, followed by bloating/distention, diarrhea, constipation, vomiting, anorexia, weight loss, fever, malaise, and nausea 2.
- Most patients with MP are asymptomatic, few will present gastrointestinal symptoms, especially abdominal pain 4.
Diagnosis
- The diagnosis is suggested by computed tomography (CT scan) and is usually confirmed by surgical biopsies 5.
- On computed tomography, MP is seen as a mass-like area of increased fat attenuation within the small bowel mesentery, usually located in the left upper quadrant of the abdomen 2.
- Lymph nodes are frequently seen within the area of mesenteric abnormality 2.
Treatment
- Because of the benign nature of MP, treatment decisions should be guided by severity of symptoms and presence of complications 2.
- First-line medical treatment is prednisone and tamoxifen 2.
- Surgery is reserved for cases of recurrent bowel obstruction 2.
- Medical treatment is unnecessary for asymptomatic patients, and the curative effect of glucocorticoids is effective in patients with symptoms 4.
- Patients on prednisolone showed good responses clinically and radiologically during follow-up 6.