WHAT IS MESENTERIC PANNICULITIS AND HOW IS IT TREATED?

Mesenteric panniculitis is a rare chronic disease that affects mesenteric fat cells. It’s also known as sclerosing mesenteritis. The mesentery is a long continuous organ that supports and attaches the small and large intestines to the abdominal walls.

The disease leads to inflammation of the fat cells, which causes the associated symptoms like abdominal pain, fever, bloating, diarrhea, and vomiting. The symptoms vary among individuals and aren’t necessarily life-threatening, but they can severely impact daily living. It could also be indicative of a more serious underlying disease.

Mesenteric panniculitis is primarily benign, but complications occur in a few cases. The intestines may get blocked if inflammation is severe and can worsen symptoms. Blocked intestines can also hinder the body’s ability to absorb food nutrients.

Treatment for most people aims to reduce symptoms and will not require further additional management or surgery. For other individuals, the condition seems to resolve itself and disappears after a few weeks to months.

How is Mesenteric Panniculitis Diagnosed?

There are three ways to make a mesenteric panniculitis diagnosis:

Physical Evaluation

A physical exam for mesenteric evaluation involves looking for a mass in the upper abdominal area. Further tests may be required to make a definitive diagnosis.

Computer Imaging

Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) tests of the abdomen may indicate the growth and progression of mesenteric panniculitis.

Tissue Biopsy

A tissue biopsy may be required in some cases to rule out the presence of other diseases like cancer and make a definitive diagnosis. A long needle inserted into the skin is used to obtain mesenteric tissue samples for biopsy.

What Causes Mesenteric Panniculitis?

The cause of mesenteric panniculitis is uncertain. Experts currently consider it an autoimmune disease, that is, the body’s defense against disease mistakes body cells for harmful invaders and attacks them. In this case, the body attacks the mesentery cells, leading to inflammation, tissue scarring, and other associated symptoms.

The progression of the disease is in three stages:

1. Lipodystrophy

Mesenteric fat tissue cells get replaced by attacking immune system cells.

2. Panniculitis

Other immune cells attack the mesentery tissue causing it to become severely inflamed.

3. Retractile Mesenteritis

Inflammation progresses to the formation of mesenteric scar tissue.

Most autoimmune diseases carry a genetic predisposition. This means that people who have relatives with a disease have a higher risk of having that disease.

People who have family members with Crohn’s disease, rheumatoid arthritis, and some other autoimmune conditions have a higher chance of developing mesenteric panniculitis.

Age and gender may also be contributing factors. Men are likelier than women to have mesenteric panniculitis, and individuals aged 60 and older report more disorder cases. Other risk factors include abdominal tissue damage resulting from accidents, infections, drug use, and surgical procedures.

The presence of certain kinds of cancers (prostate, melanoma, lymphoma, and stomach cancer) and carcinoid tumors may also be implicated in cases of mesenteric panniculitis. Diseases that can cause any tissue inflammation or scarring may also be risk factors. 

Other conditions that may be connected to the disease include:

Retroperitoneal Fibrosis

Retroperitoneal fibrosis is a rare type of abnormal tissue growth around abdominal structures within or around the peritoneum. It may cause a buildup of fibrous tissue around organs that surround the abdomen.

Riedel Thyroiditis

Riedel thyroiditis is a rare chronic inflammatory disease that causes scar tissue formation around the thyroid area.

Sclerosing Cholangitis

Sclerosing cholangitis is a rare disease that causes scar tissue formation around liver bile ducts.

Orbital Pseudotumor

Orbital pseudotumor is a disease that causes tissue inflammation in the hollow space in the skull where the eye rests – the orbit.

Symptoms of Mesenteric Panniculitis

Abdominal pain is the most common symptom of this condition. Severe inflammation of mesentery tissue causes pressure buildup around the intestines and leads to intense pain.

Although most people with mesenteric panniculitis report abdominal pain, it's not particularly indicative of the disease (Source: StuffThatWorks). Over a hundred other ailments have abdominal pain as a prominent symptom.

Other symptoms associated with the condition include:

• Loss of appetite
• Bloating
• Diarrhea
• Fever
• Weight loss
• Fatigue
• Constipation
• Nausea
• Vomiting

The presentation of symptoms may not be the same among individuals. Some people with the disease have little to no symptoms, while others may require extensive medical intervention.

Treatment of Mesenteric Panniculitis

 An individual with mesenteric panniculitis may not require treatment, depending on the severity of the condition. People who don't present symptoms will be monitored regularly to check for new developments.

The physician may use biopsy or imaging tests to assess the extent of disease progression. Mesenteric panniculitis that isn't progressing will be expected to resolve itself after a few weeks.

If the symptoms are discomforting, drugs that relieve inflammation and other symptoms may be prescribed. Anti-inflammatory medications suppress the actions of the immune system. Commonly prescribed drugs include:

Corticosteroids

Corticosteroid drugs such as prednisone and prednisolone are the most commonly prescribed drugs for mesenteric panniculitis. These drugs control inflammation but must be used cautiously because of their side effects.

Hormone Therapy

The use of prescription hormones like tamoxifen and progesterone may also reduce symptoms of mesenteric panniculitis. These hormones may be used in combination with corticosteroids and other drugs.

Other medications that find use in mesenteric panniculitis treatment include colchicine, cyclophosphamide, thalidomide, azathioprine, infliximab, low-dose naltrexone, and pentoxifylline. 

In severe cases where the disease has progressed to prevent the movement of food and nutrients through the digestive system, a surgical procedure may be required to correct the situation. Surgery is always a last resort, and a mesenteric mass is not taken out to cure the disease.

In Summary

Mesenteric panniculitis is a rare disorder and doesn't get as much attention. It's usually non-life-threatening and often goes away on its own. However, some patients may find their lives upended by the disease and will need adequate medical interventions.

Treatment is typically aimed at relieving symptoms and avoiding complications. If complications have arisen in a case, then the patient may be prepared for surgery.

Source:

• rarediseases.org/rare-diseases/mesenteric-panniculitis/
• www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
• sustainhealth.fit/lifestyle/solutions-to-common-health-conditions/
• www.stuffthatworks.health/mesenteric-panniculitis/symptoms/abdominal-pain

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