Paniculitis mesentérica / Mesenteric panniculitis

Introducción: La paniculitis mesentérica es una afección infrecuente. Aparece en la adultez tardía, con manifestaciones clínicas inespecíficas, puede cursar asintomática o caracterizarse por dolor, hinchazón y distensión abdominal, masa palpable a nivel del abdomen. Esto puede ser un hallazgo casual al realizar exploraciones radiológicas. Objetivo: Describir las características clínico-imagenológicas, así como terapéutica empleada en el tratamiento de un paciente con paniculitis mesentérica. Presentación de caso: Se presenta el caso de un paciente blanco, masculino de 59 años. Con antecedentes de hiperlipidemia, con cuadros doloroso abdominal inespecífico, de 6 meses de evolución. Se le realiza tomografía axial computarizada de abdomen simple y E/V donde se observó engrosamiento de la grasa mesentérica y múltiples imágenes nodulares a nivel del mesenterio compatible con paniculitis mesentérica. Desarrollo: La paniculitis mesentérica es una enfermedad de baja prevalencia, con mayor predominio en la sexta década de la vida, es habitualmente un hallazgo incidental en laparotomía exploratoria o tomografía computarizada de abdomen. Conclusiones: Deben conocerse las manifestaciones clínicas y hallazgos imagenológicos de la paniculitis mesentérica, así como las variantes terapéuticas en su tratamiento para evitar las intervenciones quirúrgicas innecesarias(AU)

Introduction: Mesenteric panniculitis is a rare condition. It appears in late adulthood, with nonspecific clinical manifestations, it can be asymptomatic or characterized by pain, swelling and abdominal distension, a palpable mass in the abdomen. This can be a chance finding when performing radiological examinations. Objective: To describe the clinical-imaging characteristics, as well as the therapy used in the treatment of a patient with mesenteric panniculitis. Case report: We report the case of a 59-year-old white male patient, with history of hyperlipidemia, nonspecific abdominal pain and 6 months of evolution. A simple abdominal computed tomography and E / V were performed, showing thickening of the mesenteric fat and multiple nodular images at the level of the mesentery compatible with mesenteric panniculitis. Findings: Mesenteric panniculitis is a low prevalence disease, with greater prevalence in the sixth decade of life, which is usually found incidentally in exploratory laparotomy or abdominal computed tomography. Conclusions: The clinical manifestations and imaging findings of mesenteric panniculitis must be known, as well as the therapeutic variants in its treatment to avoid unnecessary surgical interventions(AU)

Immunoglobulin G4 Unrelated Idiopathic Mesenteric Sclerosis / 대한소화기학회지

Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16–3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.

Mesenteric Panniculitis in a Thirteen-Year-Old Korean Boy Treated with Prednisolone: A Case Report / 대한소아소화기영양학회지

Pediatric mesenteric panniculitis is an extremely rare disease of unknown etiology characterized by chronic inflammation, fat necrosis, and fibrosis in the mesenteric adipose tissue. A previously healthy 13-year-old boy was admitted because of right upper abdominal pain. An abdominal computed tomography scan revealed increased attenuation and enhancement in the left upper abdominal omental fat and anterior peritoneal wall thickening. A laparoscopic biopsy showed mesenteric panniculitis with chronic inflammation, adiponecrosis, and septal fibrosis. Serological tests for autoimmune diseases, nested polymerase chain reaction for Mycobacterium tuberculosis, and special immunohistochemical stains for malignancy were all negative. Symptomatic improvement and improved abnormal findings were achieved after an 8-month treatment with prednisolone according to a follow-up abdominal computed tomography scan. Here, we report a case of pediatric mesenteric panniculitis treated with prednisolone.

Absceso mesentérico inespecífico paniculitis intra-abdominal / Abscess nonspecific mesenteric panniculitis intra-abdominal

El objetivo del presente caso clínico es mostrar los signos y síntomas que puedan determinar diagnósticos presuntivos no claros, cuándo se trata de masas mesentéricas primarias, que pueden simular patologías de origen biliar, compromiso vascular mesentérico, síndromes de FID y patologías ginecológicas dependientes de anexo derecho. La TAC es el patrón diagnóstico, que no cuentan los hospitales de segundo nivel como el nuestro, de manera que las decisiones que se toman en el servicio de emergencias, frente a este tipo de abdomen agudo quirúrgico es una laparotomía exploradora; para evitar complicaciones, no solo en órganos de la cavidad abdominal, sino también de orden legal. Los resultados de la cirugía mostraron la presencia de un masa mesentérica correspondiente a un absceso mesentérico inespecífico compatible con una paniculitis intra-abdominal, patología rara dentro la estadística nacional e internacional. Los síntomas más frecuentes son dolor abdominal, anorexia, plenitud abdominal y pérdida de peso, a veces oclusión intestinal. Otras manifestaciones comprenden: estreñimiento, fiebre, diarrea y a la palpación; masa abdominal. La duración de los síntomas es mayor a dos semanas. El laboratorio a veces es normal con aumento del VES. El contraste baritado muestra la pared del colon de aspecto irregular sin lesiones intraluminales. La ecografía; masa hiperecogenica bien definida en la raíz. La TAC: aumento de la densidad grasa, del mesenterio, bien delimitada con halo graso o pseudocapsula que rodea a los ganglios y vasos (signo del anillo graso fat-ring sign).

The present study aims to display how the patient symptomatology does not help to determine a clear presuntive diagnoses, especially when we deal with primary mesenteric masses that can simulate a biliary pathology, mesenteric vascular disorder, right lower quadrant syndrome and dependent gynecological pathologies of right annex. CT is a diagnostic pattern that second level hospitals do not have, so that decisions are taken into the emergency room. An exploratory laparatomy is the option to face up such acute abdomen in order to avoid complications in organs of abdominal cavity as well as legal problems. This case report, surgery results displayed the presence of a mesenteric mass corresponding to a non-specific mesenteric abscess compatible with a intra-abdominal panniculitis, an unusual pathology according to national and international statistics data. The most frecuent symptoms are abdominal pain, anorexia, abdominal fullness, loss of weight and sometimes intestinal occlusion. Constipation, fever, diarrhea and abdominal tenderness are additional manifestations. Those symptoms last longer than two weeks. Laboratory results display normal but with an increased ESR. Barium test shows a colon wall of irregular appearance without intraluminal injury. Ultrasound shows a hyperechoic mass well defined in the root. CT reflects an increased density of the mesenteric fat, well defined with a pseudocapsule that rounds lymph nodes and vessels (fat-ring sign).

Paniculitis mesentérica asociada a enfermedad relacionada con IgG4 como causa de fiebre de origen desconocido / Mesenteric panniculitis associated with IgG4-related disease as a cause of fever of unknown origin

La paniculitis mesentérica es un raro desorden inflamatorio de la grasa mesentérica, de la cual hay, hasta ahora, aproximadamente 200 casos reportados en la literatura. Se presenta en adultos a partir de la tercera década de la vida y su etiología es desconocida, pero es sabida su asociación con neoplasias gastrointestinales, genitourinarias y enfermedades reumatológicas. Entre sus manifestaciones clínicas están el dolor abdominal, las alteraciones del tránsito intestinal, la pérdida de peso, la fiebre y los vómitos. El diagnóstico definitivo es fundamentalmente histopatológico, también existen algunos estigmas tomográficos que podrían sugerir su presencia. Debe ser tratada a la mayor brevedad posible y los corticosteroides son los medicamentos a elegir. Se presentó un paciente con diagnóstico de paniculitis mesentérica idiopática, como resultado del estudio de una fiebre de origen desconocido, en el cual logramos además demostrar la asociación de la paniculitis con la enfermedad relacionada con IgG4, desorden recientemente descubierto, caracterizado por lesiones inflamatorias seudotumorales, que cursan con infiltración hística por células plasmáticas IgG4 positivas.

Mesenteric panniculitis is a rare inflammatory disorder of the mesenteric fat, of which there is, so far, about 200 cases reported in the literature. It occurs in elderly adults and its etiology is unknown but its association with gastrointestinal tumors, genitourinary and rheumatological diseases is known. Among its clinical manifestations are abdominal pain, altered bowel movements, weight loss, fever and vomiting. The definitive histopathological diagnosis is fundamentally, there is some tomographic stigma that might suggest its presence. It should be treated as soon as possible and corticosteroids are the drugs of choice. A patient diagnosed with idiopathic mesenteric panniculitis as a result of the evaluation of fever of unknown origin, which we further demonstrate the association of panniculitis with related disease IgG4, disorder recently discovered, characterized by lesions in flammatory pseudotumoral occurs, that occur with tissue infiltration IgG4 positive plasma cells.

Paniculitis mesentérica como causa poco frecuente de dolor abdominal agudo / Mesenteric panniculitis as a rare cause of acute abdominal pain

La paniculitis mesentérica es un proceso inflamatorio poco habitual que afecta al tejido graso del mesenterio y, con menor frecuencia, al mesocolon o al retroperitoneo. Puede cursar con dolor abdominal, diarrea, pérdida de peso o masa palpable, y rara vez se presenta con un cuadro de dolor abdominal agudo. En la mayoría de los casos es asintomática. La etiología es desconocida, aunque se han descrito como posibles agentes causales la isquemia, la infección, el traumatismo abdominal, los antecedentes quirúrgicos y los procesos autoinmunes. También se ha planteado su asociación con determinados fármacos, procesos inflamatorios idiopáticos y neoplasias. La tomografía computada (TC) es la técnica de imagen de elección para su diagnóstico y los hallazgos pueden variar desde el incremento de la atenuación en el mesenterio hasta la presencia de una masa sólida en relación con el componente tisular predominante (grasa, tejido inflamatorio o fibrosis). Presentamos 3 pacientes que acudieron al Servicio de Urgencias con dolor abdominal agudo y cuyo diagnóstico final fue paniculitis mesentérica como causa del cuadro.

Mesenteric panniculitis is an unusual inflammatory disorder involving the adipose tissue of the mesentery and, less frequently, the mesocolon and the retroperitoneum. Patients may present with abdominal pain, diarrhea, weight loss or abdominal mass, and only rarely with symptoms of acute abdominal pain. In most cases, it is asymptomatic. Although the etiology of mesenteric panniculitis is unknown, ischemia, infection, abdominal trauma, previous abdominal surgery, and autoimmune disorders have been reported as possible causative agents. It has also been suggested its association with certain drugs, idiopathic inflammatory processes, and malignancy.Computed tomography (CT) is the gold standard imaging technique for its diagnosis; computed tomography findings may vary from increased attenuation of the mesentery to a solid soft-tissue mass depending on the predominant tissue component (fat, inflammation or fibrosis). We report 3 cases of patients who presented at the Emergency Department with acute abdominal pain and were diagnosed with mesenteric panniculitis.

Mesentric Panniculitis : A Rare Clinical Entity.

Mesenteric panniculitis is a rare, fibrosing inflammatory disease of the mesentery. Its presents with a variety of symptoms and is diagnosis is mostly by CT scan abdomen. We present a case report of a 48 years old gentleman with symptoms of mainly pain abdomen. He was treated conservatively and subsequently improved.

Paniculite mesentérica pseudotumoral: aspectos tomográficos de um caso / Pseudotumoral mesenteric panniculitis: tomographic findings in a case

A paniculite mesentérica representa um processo inflamatório do mesentério de ocorrência rara e etiologia desconhecida, que apenas em alguns poucos casos pode se manifestar sob a forma de pseudotumores abdominais. Descreve-se, enfatizando os aspectos tomográficos, um raro caso de paniculite mesentérica que se apresentou inicialmente como um pseudotumor que envolvia a região peripancreática.

Mesenteric panniculitis is a rare inflammatory process of the mesentery whose etiology is unknown that in only very few cases may present as an abdominal pseudotumor. The authors report a rare case, emphasizing the tomographic findings of mesenteric panniculitis that initially presented as a pseudotumor involving the peripancreatic region.

Paniculitis mesentérica: ¿predictor de una neoplasia? / Mesenteric panniculitis: predictor of a neoplasm

Introduction: Mesenteric panniculitis is a rare disorder characterized by chronic, non-specific inflammation involving the adipose tissue of the bowel mesentery of unknown aetiology. It has been associated with different processes, including digestive and urothelial malignancies. Case report: A 44-years-old man carne to the Emergency Department complaining of mesogastric pain for the last 24 hours. CT sean showed an increased density of the mesenteric adipoid tissue. Mesenteric paniculitis was diagnosed and antibiotic treatment was instaured. The patient recovered uneventfully. Two months later the patient was diagnosed of an infiltrating urothelial carcinoma. Conclusions: Mesenteric panniculitis may be associated with malignancies and other pathologies. It is advisable to perform tests to dismiss the coexistence of these disorders. In those cases, in which associated diseases could not be demonstrated, a frequent follow-up would be advisable to achieve an early diagnosis if these appear.

Introducción: La paniculitis mesentérica es un trastorno poco frecuente caracterizado por inflamación crónica inespecífica del tejido adiposo del mesenterio intestinal de etiología desconocida. Se ha relacionado con diversas patologías, entre ellas neoplasias digestivas y uroteliales. Caso clínico: Varón de 44 años que acude a Urgencias por un dolor mesogástrico de 24 horas de evolución. En la TC abdominal se objetivó un aumento de densidad de la grasa de la raíz del mesenterio. Se diagnosticó de paniculitis mesentérica y se trató mediante antibioterapia. A los 2 meses el paciente es diagnosticado de un carcinoma urotelial infiltrante. Discusión: La paniculitis mesentérica puede estar relacionada con neoplasias y otras patologías. Es conveniente realizar pruebas para descartar la coexistencia de alguna de las enfermedades asociadas. En aquellos casos en los que no se demuestre, sería recomendable un seguimiento periódico.

Paniculite mesentérica (PM) e fibromatose mesentérica (FM): relato de casos / Mesenteric panniculitis (MP) and mesenteric fibromatosis (MF): report of cases

A paniculite mesentérica (PM) e a fibromatose mesentérica (FM) são doenças fibróticas de etiologia incerta. São mais frequentes no mesentério do intestino delgado, no grande omento e nos mesocólons. Clinicamente a FM pode apresentar-se de forma aguda na qual uma complicação da doença é sua primeira expressão. Na forma crônica é caracterizada por sintomas abdominais vagos e/ou massa abdominal palpável. A comprovação diagnóstica, assim como na PM, é feita através de laparotomia exploradora ou videolaparoscopia diagnóstica e biopsia. Os autores relatam dois casos sendo um de PM e outro de FM, apresentam um paralelo dos aspectos clínicos, tomográficos, diagnóstico, histopatológico e terapêutico destacando as semelhanças e as diferenças entre essas duas patologias.

Mesenteric panniculitis (MP) and mesenteric fibromatosis (MF) are fibrotic diseases of uncertain aetiology. Both occur most frequently in the mesentery of the small intestine, the greater omentum and the mesocolons. In its acute form, the first clinical symptoms of MF are complications of the disease. Chronic MF is characterized by vague abdominal symptoms and/or a palpable abdominal mass. Like mesenteric panniculitis, mesenteric fibromatosis can be diagnostically verified by exploratory laparotomy, or diagnostic video-laparoscopy and biopsy. Here, we present two cases, one of MP and the other of MF, with resembling clinical and tomographic aspects, as well as similarities in diagnosis, histopathology and therapy. With our case report, we want to emphasise both similarities and differences between these two pathologies.

Paniculitis mesentérica asociada con absceso intraabdominal / Mesenteric panniculitis with intraabdominal abcess: report of one case

La paniculitis mesentérica es una enfermedad inflamatoria del tejido adiposo del mesenterio, de presentación infrecuente y que se caracteriza, por el engrasamiento, endurecimiento y nodularidad del mismo. Se pone en consideración un caso clínico en un varón joven, con una forma de presentación poco común que requirió de laparotomía exploradora para realizar el diagnóstico y tratamiento.

We report a 28 years old obese male presenting with abdominal pain of increasing intensity lasting 15 days. In the last days, diarrhea and fever appeared. On abdominal examination a 8 cm painful mass was palpated. An abdominal ultrasound showed an anechoic mass in the epigastrium. An abdominal CAT sean showed an inflammatory mass that involves the small bowel. The patient is subjected to a percutaneous needle aspiration, obtaining 50 mi of a purulent fluid. Due to persistence of fever, the patient was operated finding an inflammation that involved the mesentery and the great omentum and covering abscess. The pathologic study of the surgical piece reported a unspecific nodular mesenteric panniculitis.

Four Cases of Postoperative Sclerosing Mesenteritis

Mesenteric panniculitis is an extremely rare inflammatory condition of the adipose tissue of unknown etiology. It is characterized by extensive, progressive fibrosis of the mesenteric fat tissue, leading to tumor formation. Clinical manifestations vary according to the process involving the structures. Abdominal pain accompanied by nausea, malaise, pyrexia, and weight loss and a poorly defined mass are common presentations. Major pathologic changes include (1) degeneration of mesenteric fat, (2) an inflammatory reaction, and (3) fibrosis of the adipose tissue. We present four patients with an aggressive form of mesenteric pannicultis with characteristic histopathologic features. We discuss the relationship between the histopathologic features and the surgical intervention in these cases.

Sclerosing Mesenteritis

Sclerosing mesenteritis is a rare condition; it's an idiopathic nonspecific inflammatory process in the adipose tissue of the small bowel mesentery. It often develops into huge masses that contain necrotic fat, and these masses mimick malignancy. It has two pathologically different variants: mesenteric panniculitis (acute or subacute) and retractile-mesenteritis (chronic). Although infection, trauma, local ischemia, surgery and malignancy have been implicated in the etiology of this disease, the exact causes are unknown. The disease usually has a favorable prognosis. The diagnosis is confirmed by biopsy. A 59 year-old man visited in our hospital with vague abdominal pain and diarrhea that he had suffered with during the previous three months. A computed tomography (CT) scan showed a dilated small intestine and also masses in the small bowel mesentery. On the operative findings, fibrous masses were noted in the mesentery. The pathologic report revealed sclerosing mesenteritis. We report here on a case of sclerosing mesenteritis along with a review of the literatures.

Cases of Postoperative Mesenteric Panniculitis

Mesenteric panniculitis is a rare inflammatory condition of mesenteric adipose tissue in which the mesentery is replaced with fibrosis. The frequent symptoms of mesenteric panniculitis are palpable mass, abdominal pain and gastrointestinal obstructive symptoms. In the majority of cases, its course is self-limiting and the prognosis is favorable. 3 cases of mesenteric panniculitis are described that presented with obstructive symptoms of gastrointestinal tract, which occurred in 2 weeks following colectomy of colonic tumors. And reviewed the symptomatology, pathology, treatment, and outcome of this disorder.