What Is Mesenteric Panniculitis

Overview

The region of the human body called the abdomen, is a significant but sensitive cavity that houses many essential organs such as the stomach, small intestine, large intestine, etc. Have you ever wondered how a compactly coiled organ like the small intestine stays attached to the abdomen?

It is basically through the help of a fold of membrane called the mesentery. The mesentery plays a critical role in adulthood but also during the embryological stages of a human. During this period, the mesentery serves as the source of development of the digestive organs located in the abdominal region. It is said that a human cannot remain alive without the mesentery.¹ Recent studies have shown that the mesentery is a single, uninterrupted organ composed of tissues. 

Mesenteric panniculitis is regarded as a rare disease that involves the fat tissues of the mesentery. It is a chronic fibrosing inflammatory disease that is benign. The adipose or fat tissues inflame, degrade, and fat necrosis is also observed. A complication would include chronic inflammation.² This condition is also known under other names such as sclerosing mesenteritis, retractile mesenteritis, mesenteric lipomatosis, liposclerotic mesenteritis, and isolated lipodystrophy of the mesentery.⁵ 

Causes of mesenteric panniculitis

The mesentery is basically a tissue fold found within the peritoneum or the serous membrane that lines the abdominal cavity.² The disease is not fully understood yet and is still under research. The medical community classifies mesenteric panniculitis under autoimmune diseases. It is often said that patients suffering from mesenteric panniculitis would also have family members affected with autoimmune disease.³ 

Most cases of mesenteric panniculitis, around 90%, are said to target the small intestine. It is also noted that the occurrence of this condition is more prominent in males than females, where 3% of the males are affected in contrast to 1.5% of the population.⁴ This condition can also arise following abdominal surgery. Mesenteric panniculitis can also occur in treated cancer patients or individuals yet to be diagnosed. This accounts for 30% of the cases. Cancers of the kidney, colon, prostate, and even lymphoma are related to this condition.³

There are also a few conditions that cause chronic inflammation and lead to scarring or sclerosing situations like Crohn’s Disease, which is also a type of inflammatory bowel disease and also is an autoimmune disease, and nodular panniculitis. This is another cause of mesenteric panniculitis.³

Sometimes in cases of infection, an immune response would take place, wherein the leucocytes or the white blood cells would participate in fighting off the infectious, foreign particles. This reaction releases products such as cytokines, which can also be regarded as a trigger to aggravate the existing problem and can pave the route for mesenteric panniculitis. Examples of some chronic bacterial infections that can lead to mesenteric panniculitis are cholera, tuberculosis, typhoid, syphilis, etc.³

Due to certain genes, antigens, and allergens,³ there may be a heightened immune response that can cause hypersensitivity.⁵ This phenomenon is sometimes an underlying mechanism of a couple of autoimmune diseases. In times of abdominal injuries or trauma, excessive blood loss can lead to a higher infection susceptibility which leads to further damage to the soft organs present in the region.³

Signs and symptoms of mesenteric panniculitis

The medical field states that most of the affected individuals are asymptomatic,³ but some show symptoms. Some of the basic symptoms like fever and fatigue are observed due to an immune response. The exact origin of this condition still remains unknown. The clinical symptoms are known to vary based on the underlying medical issues of the concerned patient. The advancement of mesenteric panniculitis can range from two weeks to even sixteen years.⁵ Sometimes, the case of mesenteric panniculitis in a patient can be very mild and subtle and can disappear on its own.³

In the case of mesenteric panniculitis arising due to an infection caused by a pathogen, the lymph nodes tend to swell up, indicating an ongoing immune response. Inflammation of the mesentery can also cause abdominal pain and swelling of lymph nodes. Some symptoms focused on the abdominal region such as bloating and swelling can also be noticed along with nausea, vomiting, and diarrhoea.³

Weight loss is seen as well, which in some cases can morph into a long-term condition called anorexia nervosa. Serious symptoms such as jaundice, and bleeding of the rectum (The rectum is the portion of the large intestine that succeeds the colon and preceeds the anal canal. It stores faecal matter temporarily till it is ready to be expelled. Since the rectum starts bleeding, blood is passed along with stool), and acute abdomen, which indicates severe and sudden pain in the abdomen.⁵

The final stage of mesenteric panniculitis is retractile mesenteritis, which basically involves the deposition of collagen, which causes scarring and mesenteric retraction which finally paves the way to the formation of abdominal masses.⁵

Management and treatment for mesenteric panniculitis

To manage conditions like mesenteric panniculitis, it is important for the individual to follow an anti-inflammatory diet. Food like tuna, nuts, salmon, whole and leafy green vegetables, whole grains, olive oil, and turmeric are excellent choices for decreasing inflammation. Alcohol, red meat, lard, shortening, margarine, fried food, and processed food must be avoided at all costs.³

The treatment plan for mesenteric panniculitis would be tricky to formulate since there are multiple causes and many underlying medical issues that need to be taken into consideration. 

A common medication that is utilised to treat includes a class of steroid hormone-based drugs such as corticosteroids. Corticosteroids mimic a hormone produced by the adrenal gland called cortisol. The main function of cortisol is to act as a natural anti-inflammatory. These man-made compounds are preliminary drugs administered to the patient that decrease inflammation.³ Some corticosteroids also act as immunosuppressants.

The next class of drugs called immunosuppressants are used if symptoms still prevail. These drugs reduce the immunity of the patient along with some serious side effects. Some examples of immunosuppressants used to treat mesenteric panniculitis include colchicine, azathioprine, infliximab, etc.²

Diagnosis

The diagnosis of mesenteric panniculitis can either be done through radiology, which is done by scans, or by studying the tissues known as histopathology.⁶

To visualise and assess inflammation in the abdomen, the most popular method is Computed Tomography or CT scan. A solid mass of fat in the mesentery is seen through this scan. A biopsy of the suspected parts is then carried out, which exhibits necrosis of fat, fibrosis, and chronic inflammation.⁶ The diagnosis can also be difficult since there are multiple causes and many underlying medical issues that need to be considered.⁶

FAQs

How can I prevent mesenteric panniculitis?

It is essential for the patient to follow an anti-inflammatory diet, like the Mediterranean diet. Food like tuna, whole and leafy green vegetables, whole grains, olive oil, and turmeric are excellent choices for reducing inflammation. Alcohol, red meat, lard, fried food, and processed food like carbonated drinks must be avoided at all costs. Only purified water must be consumed and raw meat must be completely avoided to reduce the risk of infections, which can give rise to mesenteric panniculitis.

How common is mesenteric panniculitis?

Mesenteric panniculitis is regarded as a rare disease. It is also noted that the occurrence of this condition is more prominent in males than females, where 3% of the males are affected in contrast to 1.5% of the population. 

Who is at risk of mesenteric panniculitis?

Some risk factors of mesenteric panniculitis include abdominal trauma and surgery. Mesenteric panniculitis can also occur in treated cancer patients or individuals yet to be diagnosed with cancer. This comprises 30% of the recorded cases. Cancers of the kidney, colon, prostate, and even lymphoma are related to this condition.

When should I see a doctor?

Since many people are asymptomatic, these cases usually remain undiagnosed. When symptoms such as abdominal swelling and bloating, rapid weight loss, anorexia nervosa, rectal bleeding, etc., are observed, it is advised to visit the doctor immediately.

Summary

The mesentery is a single, uninterrupted organ of the abdomen, composed of tissues, which plays a critical role in adulthood but also during embryological stages. During this period, the mesentery serves as the source of development of the digestive organs located in the abdominal region.

Fat tissues in the mesentery are affected by mesentery panniculitis, a rare disease. It is also observed that adipose or fat tissues inflame, degrade, and suffer from necrosis. Research is still underway to fully understand the disease. Males are more likely to suffer from this illness than females, with 3% of the male population being affected compared to 1.5% of the female population.

It is also possible for this condition to develop following abdominal surgery. Patients with cancer who have been treated or those who have not yet been diagnosed can also develop mesenteric panniculitis. About 30% of the cases fall into this category. Cancers of the kidney, colon, prostate, and even lymphoma are related to this condition.

Clinical symptoms vary based on the underlying medical issues of the patient. The duration of mesenteric panniculitis can range from two weeks to even sixteen years. Sometimes, mesenteric panniculitis in a patient can be very mild and subtle and disappear on its own. Some abdominal symptoms such as bloating and swelling can also be noticed along with nausea, vomiting, and diarrhoea. Serious symptoms such as jaundice, and bleeding of the rectum are seen.

A common medication that is used to treat includes a class of steroid hormone-based drugs such as corticosteroids that decrease inflammation. The next class of drugs called immunosuppressants are prescribed if symptoms still persist. Some examples of immunosuppressants used to treat mesenteric panniculitis include colchicine, azathioprine, and infliximab.