Michael P. Buetow
, MD of Lansing Radiology Associates, Sparrow Health System,
A 60-year-old woman presented with a 2-month history of
abdominal pain. Her laboratory values were normal, including
amylase and lipase levels. An abdominal computed tomography (CT)
scan was performed (Figure 1).
A contrast-enhanced CT scan of the abdomen demonstrates
infiltration of the mesentery surrounding the mesenteric root
(Figure 1). Because of recalcitrant symptoms, an exploratory
laporatomy was eventually performed. Biopsies demonstrated vascular
congestion with chronic inflammatory infiltrate and panniculitis.
No other abnormality was discovered by imaging or at surgery.
Mesenteric panniculitis is a form of chronic inflammation of
adipose tissue of the bowel mesentery. It is known by different
names, including sclerosing mesenteritis, mesenteric lipodystrophy,
and liposclerotic mesenteritis. It has been described as one stage
of the three manifestations of mesenteric fat degeneration, which
starts as mesenteric lipodystrophy with fatty degeneration,
followed by mesenteric panniculitis with mesenteric inflammation,
and ending in retractile mesenteritis with fibrosis. However, there
is no evidence that this sequence occurs in all patients.
Both pancreatitis and inflammatory bowel disease should be
excluded before the diagnosis of mesenteric panniculitis is
established. It has been associated with concurrent malignancy in
up to 70% of cases, but a pathologic link has not been described.
Additionally, up to 90% of patients with mesenteric panniculitis
are asymptomatic. In fact, mesenteric panniculitis is frequently an
incidental finding on abdominal CT scan. An autoimmune etiology has
been conjectured as a cause for the inflammatory process, but this
remains to be proven.
Mesenteric panniculitis is seen on CT scans of the abdomen as
infiltration of the mesentery secondary to inflammation, sometimes
with small soft-tissue nodules and vessels surrounded by a
hypodense fatty halo. It is more commonly seen on the left side of
the abdomen along the orientation of the jejunal mesentery.
Although mesenteric panniculitis is frequently concurrent with
malignancy, it is a benign condition. It typically resolves without
treatment. Steroids have been shown to have a possible benefit
toward decreasing inflammation, but surgery is not indicated.
Mesenteric panniculitis is a benign inflammatory condition of
the mesentery, which is frequently asymptomatic and usually