Mesenteric panniculitis is a rare, benign and chronic fibrosing inflammatory disease that affects the adipose tissue of the mesentery of the small intestine and colon. The specific etiology of the disease is unknown. The diagnosis is suggested by computed tomography and is usually confirmed by surgical biopsies.

What is it?

  • Mesenteric panniculitis is a rare disease that affects the part of the mesentery that contains fat cells.
  • The mesentery is a continuous fold of tissue in your abdomen.The mesentery is important because it supports your intestines and attaches them to the abdominal wall of your body.
  • The specific cause of mesenteric panniculitis isn’t known, but may be related to autoimmune disease, abdominal surgery, injury to your abdomen, bacterial infection, or vascular problems. It causes chronic inflammation that damages and destroys fatty tissue in the mesentery. Over time, this can lead to scarring on the mesentery.

The stages of the condition:

  • Mesenteric lipodystrophy is the first stage. A type of immune system cell replaces fat tissue in the mesentery.
  • Mesenteric panniculitis is the second stage.
Additional types of immune system cells infiltrate the mesentery, and a lot of inflammation occurs during this stage.
  • Retractile mesenteritis is the third stage. It’s when the inflammation is accompanied by scar tissue formation in the mesentery.
  • Mesenteric panniculitis typically isn’t life-threatening. It may go away on its own, or it could develop into a severe disease. But while the inflammation is there, it can cause pain and other symptoms that interfere with your life. Your doctor can give you medicine to manage this inflammation and control symptoms.

    What are the symptoms?

    Symptoms vary from person to person. The clinical course may vary from no symptoms to severe and aggressive disease.
    If there’s enough inflammation in the mesentery, the swelling can put pressure on organs near your intestines. This pressure can cause abdominal pain.

    Other common symptoms include:

    • nausea
    • vomiting
    • diarrhea
    • constipation
    • feeling full quickly after you eat
    • loss of appetite
    • weight loss
    • bloating
    • lump in your abdomen
    • fatigue
    • fever

    Symptoms can last for a few weeks or months, and then go away.

    Although the exact cause isn’t known, doctors think mesenteric panniculitis is possibly a type of autoimmune disease. Normally, your immune system fights off bacteria, viruses, and other germs that can make you sick. In an autoimmune disease, your immune system mistakenly attacks your body’s own tissues. In this case, it attacks the mesentery. This attack produces the inflammation that causes symptoms.

    How is it diagnosed?

    • Mesenteric panniculitis is often misdiagnosed because it’s so rare. Sometimes doctors discover the disease incidentally when they do a CT scan to look for the cause of abdominal pain. This test can detect any signs of thickening or scarring in your mesentery.
    • To make a diagnosis, your doctor may also have you undergo one or more blood tests to look for markers of inflammation in your body. This includes checking your erythrocyte sedimentation rate and C-reactive protein level.

    How do you treat it?

    • People with mesenteric panniculitis may not need treatment. Your doctor will monitor your symptoms and may do repeat CT scans to see if the inflammation is getting worse. It’s possible for mesenteric panniculitis will go away on its own within a few weeks or months.
    • If your symptoms bother you or they cause complications, your doctor will give you medicine to bring down inflammation in your body. Many of the drugs used to treat this condition work by suppressing the overactive immune system response. Corticosteroid drugs are often used to treat mesenteric panniculitis.

    Other medicines that treat this condition include:

    • azathioprine (Imuran)
    • colchicine (Colgout)
    • cyclophosphamide
    • infliximab (Remicade)
    • naltrexone (Revia) at a low dose

    How do you live with it?

    The goals of treatment for mesenteric panniculitis are reduction of mesenteric inflammation and the control of symptoms of the disease.Generally, individuals with no symptoms are not treated, but are regularly monitored to see whether the disorder progresses on abdominal imaging (watch and wait approach). A decision regarding biopsy is made during this time. In most patients, the disease remains asymptomatic. The mesenteric mass is generally stable or even regresses on its own.

    For patients with symptoms related to chronic mesenteric inflammation, anti-inflammatory agents, especially corticosteroids are the initial treatment of choice. Additional anti-inflammatory drugs that have been used to treat mesenteric panniculitis include colchicine, azathioprine, cyclophosphamide, infliximab and pentoxifylline. A prospective clinical trial has demonstrated that the drug thalidomide improves symptoms and reduces blood levels of ESR and CRP in patients with mesenteric panniculitis. Low dose naltrexone (LDN) is also a promising new therapy for mesenteric panniculitis. LDN appears to work by modulating immune system and by increasing blood levels of enkephalins and endorphins.

    Author: Garvan James Lynch B.Sc.(Gen) N.U.I. B.Sc.(Hons) G.R.S.C. B.Sc.(Hons) Pharm. M.P.S.I. M.R.Pharm.S. M.B.A.(Healthcare) D.I.C.


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