• abdominal pain
• histologic diagnosis
• imaging
• incidental finding
• intestinal occlusion
• sclerosing mesenteritis
• surgery

• colon cancer
• colonoscopy
• mesenteric panniculitis
• mortality

• asymptomatic
• benign course
• long-term observation
• mesenteric mass
• sclerosing mesenteritis

• Abdominal pain
• CT
• Chronic
• Mesenteric panniculitis

• Humans
• Female
• Male
• Adult
• Middle Aged
• Aged
• Aged, 80 and over
• Panniculitis, Peritoneal/complications
• Panniculitis, Peritoneal/diagnosis
• Panniculitis, Peritoneal/therapy
• Prednisone
• Neoplasm Recurrence, Local
• China
• Abdominal Pain/etiology
• Anti-Bacterial Agents/therapeutic use

• Autopsy
• Case Reports
• Fatal Outcome
• Panniculitis, Peritoneal
• Pediatrics

• Computed tomography
• Mesenteric panniculitis
• Neoplasms
• Panniculitis
• Peritoneal

• adipose tissue
• autoimmune disease
• computerized tomography
• laparoscopy
• lymphatics
• lymphoma
• mesenteric fibrosis
• mesenteric lipodystrophy
• mesenteric panniculitis
• neoplasms
• paraneoplastic conditions
• positron emission tomography
• retractile mesenteritis
• sclerosing mesenteritis

• Colchicine
• Management
• Outcome
• Sclerosing mesenteritis
• Tamoxifen

• abdominal wall
• hernia, inguinal
• panniculitis, peritoneal

• Aged, 80 and over
• Female
• Humans
• Intestinal Obstruction
• Intestine, Small
• Mesentery
• Neoplasms
• Panniculitis, Peritoneal/diagnostic imaging

Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine, with an insidious clinical presentation having symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss. We report a case of a 23-year-old male presenting with palpable abdominal mass, mesogastric pain, and a history of rapid weight loss, who underwent exploratory laparoscopy. A hemorrhagic and gelatinous nodular tumor mass of the mesentery was identified and the surgical procedure was converted to a laparotomic approach. Histologically, the mass was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells (lymphocytes, plasma-cells, and histiocytes) were also evident. The diagnosis of sclerosing mesenteritis was made. Our case emphasizes that histology remains pre-eminent for a correct diagnosis of SM, as pre-operative radiological-based diagnosis is non-specific.

• abdominal mass
• fibroinflammatory disease
• mesenteric mass
• sclerosing mesenteritis
• small bowel obstruction

Sclerosing mesenteritis (SM) is an idiopathic disorder affecting mesentery, characterized by fat necrosis, chronic inflammation and fibrosis. The clinical presentation varies from asymptomatic cases to acute abdomen. The diagnosis is suggested by imaging but can be definitely established only by biopsies. In this paper, we discuss ultrasonography-based management of SM.

• mesenteric lipodystrophy
• mesenteric panniculitis
• retractile mesenteritis
• sclerosing mesenteritis
• ultrasonography

Patient: Male, 33-year-old

Final Diagnosis: Sclerosing mesenteritis

Symptoms: Abdominal pain • diaphoresis • nausea • tachycardia

Medication:—

Clinical Procedure: Exploratory laparotomy

Specialty: Surgery

The mesenteric panniculitis is a rare form of inflammation that mainly involves the mesenteric adipose tissue. The etiology remains unknown and the disease has been associated with various conditions such as cancer, abdominal trauma, previous surgery, autoimmune diseases and obesity. Mesenteric panniculitis can be divided into two main groups: the mesenteric panniculitis with only the inflammation and degeneration of the mesenteric fat, and the retractile panniculitis, mainly fibrotic, with retraction of the surrounding structures. From a radiological point of view, there are two main signs: the fat ring sign, which is the presence of normal fat around vessels and lymph nodes, and the pseudocapsula around the lesion. In this paper, we present the imaging and clinical features of mesenteric panniculits with particular reference to the differential diagnosis and the possible etiological associations. (www.actabiomedica.it)

Mesenteric panniculitis (MP) is a relatively rare pathology characterized by idiopathic local chronic inflammation of adipose tissue, mainly affecting the mesentery of the small intestine. The purpose of the study is to describe a case of MP. A 60-year-old patient visited a rheumatologist due to the progressive deterioration of his condition for the last 4 months and revealed changes on the computed tomography of the abdominal cavity. Treatment protocol: methylprednisolone 8 mg/day, pantoprazole 40 mg/day; continue with antihypertensive drugs. On the background of treatment after 2 months, the temperature became normal, appetite improved, and weakness decreased, with no relapses of abdominal symptoms. Diagnosis of MP is a difficult task, which has to be solved by primary care specialists. This clinical case is an example of MP diagnosis and positive dynamics of the patient’s clinical condition during therapy.

• computed tomography
• mesenteric panniculitis
• rheumatic diseases

• Gastrohepatic omentum
• Lesser omental panniculitis
• Lesser omentum
• Omentitis
• Panniculitis

• drug therapy related to surgery
• gastrointestinal surgery
• small intestine

A 65-year-old man had intermittent abdominal pain for the previous 2 years. This pain suddenly became worse with a fever and elevated inflammatory markers. We took a while to diagnose the patient with mesenteric panniculitis (MP). Although imaging findings suggested MP, we needed to rule out other diseases. Choosing a treatment for the patient also took some time and we finally used glucocorticoid to cure the patient.

• Mesentery
• computed tomography
• diagnosis
• glucocorticoid treatment
• methylprednisolone
• panniculitis

The aim was to compare computed tomography (CT) findings between patients with mesenteric panniculitis (MP) with and without known malignancy.

We retrospectively analyzed 116 consecutive patients who were diagnosed with MP on the basis of CT findings and categorized them according to the absence (Group 1: 73 patients) or presence (Group 2: 43 patients) of malignancy. Patient age and sex, diameter, size, mass effect, location, and fat density of the MP mass, presence of a pseudocapsule and/or halo sign, and lymph node status were compared between the two groups.

MP tends to be more common in males, and this trend shows statistical significance when combining the findings for both groups (P=0.041). Patients in Group 1 were significantly younger than those in Group 2 (54.29 vs 64.77 years, P=0.001). A well-defined fatty mass at the small bowel root was observed in all patients. The halo sign was present in most cases in both groups. A pseudocapsule was observed in 36 patients (49%) in Group 1 and 29 (67%) in Group 2 (P=0.045). The average craniocaudal diameter of the MP masses on the sagittal view was 11.14 and 12.5 cm in Groups 1 and 2, respectively (P=0.005). The MP fat density was less negative in patients with malignancy (–66 vs –76 HU, P=0.001). Lymph node status was similar in both groups.

Detailed CT features should be evaluated in patients with MP, as some of these features may indicate an associated malignancy, necessitating further investigation and close follow-up.

• imaging
• mesenteric inflammation
• paraneoplastic

• Mesenteric fibrosis
• Mesenteric malignancy
• Mesenteritis

• Sclerosing mesenteritis
• mesenteric lipodystrophy
• mesenteric panniculitis
• retractile mesenteritis

• Adult
• Aged
• Aged, 80 and over
• Appendectomy
• Breast Neoplasms/epidemiology
• Cholecystectomy
• Colectomy
• Colorectal Neoplasms/epidemiology
• Comorbidity
• Female
• Herniorrhaphy
• Humans
• Hysterectomy
• Jordan/epidemiology
• Lymphoma/epidemiology
• Male
• Middle Aged
• Multidetector Computed Tomography
• Neoplasms/epidemiology
• Panniculitis, Peritoneal/diagnostic imaging
• Panniculitis, Peritoneal/epidemiology
• Prevalence
• Prostatic Neoplasms/epidemiology
• Retrospective Studies
• Young Adult

Sclerosing mesenteritis is a rare disease of the mesentery. Associations with surgery, trauma, autoimmunity and paraneoplastic syndrome have been suggested, but most of the cases remain idiopathic. Diagnosis is often incidental, based upon the finding of a single or multiple mesenteric lesions on abdominal CT and histopathological confirmation. Optimal treatment is still controversial, but most of the cases reported have a favourable prognosis. We present a case of a 54-year-old male with long-standing abdominal pain and nausea, whose CT revealed the presence of a large mesenteric mass. A biopsy was performed, revealing benign chronic inflammation, fibrosis and IgG4-positive plasmocytes consistent with sclerosing mesenteritis. Clinical remission was achieved with corticosteroids and follow-up CTs at six and twelve months documented stability of the lesion. Furthermore, we review the current literature on the diagnosis and treatment options for this rare disease.

• Sclerosing mesenteritis
• mesenteric mass
• mesenteric panniculitis

• Clinical classification
• Mesenteric panniculitis
• Mesenteritis
• Panniculitis
• Radiological classification
• Retractile mesenteritis
• Sclerosing mesenteritis

• Antibiotics
• Idiopathic mesenteric panniculitis
• Nonsteroidal anti-inflammatory drugs
• Treatment

• Adult
• Aged
• Anti-Bacterial Agents/therapeutic use
• Anti-Inflammatory Agents/therapeutic use
• Diagnosis, Differential
• Female
• Humans
• Male
• Middle Aged
• Panniculitis, Peritoneal/diagnosis
• Panniculitis, Peritoneal/drug therapy
• Panniculitis, Peritoneal/epidemiology
• Panniculitis, Peritoneal/physiopathology
• Prevalence
• Retrospective Studies
• Tomography, X-Ray Computed

• Computed tomography
• Lymphoma
• Misty mesentery
• Neoplasms
• Panniculitis
• Peritoneal
• Positron emission tomography
• Small intestine
• Tomography
• X ray

• Abdomen/diagnostic imaging
• Biopsy
• Carcinoma, Renal Cell/diagnostic imaging
• Carcinoma, Renal Cell/pathology
• Databases, Factual
• Diagnosis, Differential
• Early Detection of Cancer/methods
• Electronic Health Records
• Humans
• Kidney Neoplasms/diagnostic imaging
• Kidney Neoplasms/pathology
• Longitudinal Studies
• Lymphoma/diagnostic imaging
• Lymphoma/epidemiology
• Male
• Mesentery/pathology
• Panniculitis, Peritoneal/diagnostic imaging
• Panniculitis, Peritoneal/epidemiology
• Peritoneal Neoplasms/diagnostic imaging
• Peritoneal Neoplasms/epidemiology
• Peritoneal Neoplasms/secondary
• Positron-Emission Tomography
• Prostatic Neoplasms/diagnostic imaging
• Prostatic Neoplasms/pathology
• Retrospective Studies
• Tomography, X-Ray Computed
• United States/epidemiology

• Child
• Mesenteric panniculitis
• Prednisolone

Adipose tissue does not belong to the most favorite structures to be visualized by ultrasound. It is not, however, free from various pathologies. The aim of this paper is to make abdominal cavity examiners more familiar with non-cancerous lesions found in intra-abdominal fat. The main focus is lesions that are rarely discussed in the literature. Visceral adiposity is one of important pathogenetic factors contributing to cardiovascular events, metabolic syndrome and even certain neoplasms. That is why this article exposes sonographic features that are the most characteristic of these lesions. The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way. Moreover, the article discusses more and more common mesenteritis, the lack of knowledge of which could pose difficulties in explaining the nature of symptoms reported by patients. Furthermore, this review presents lesions referred to in the literature as focal infarction of intra-abdominal fat. This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis. These lesions should be assessed with respect to the clinical context, and appropriate techniques of ultrasonography should be employed to allow careful determination of the size, shape, acoustic nature and location of lesions in relation to the integuments and large bowel, as well as their reaction to compression with an ultrasound transducer and behavior during deep inspiration. Moreover, each lesion must be obligatorily assessed in terms of blood flow. Doppler evaluation enables the differentiation between primary and secondary inflammation of intra-abdominal fat. The paper also draws attention to a frequent indirect sign of a pathological process, i.e. thickening and hyperechogenicity of fat, which sometimes indicates an ongoing pathology at a deeper site. This structure may completely conceal the primary lesion rendering it inaccessible for ultrasound. In such cases and in the event of other doubts, computed tomography should be the next diagnostic step.

• differential diagnosis
• fat necrosis
• intra-abdominal fat
• non-cancerous lesions
• ultrasound imaging

Systematic review to determine any association between imaging features of idiopathic mesenteric panniculitis (MP) and subsequent malignancy.

Two researchers searched primary literature independently for imaging studies of MP. They extracted data focusing on methodology for unbiased patient accrual and capability to determine a link between MP and subsequent malignancy. They noted imaging features of MP. Data were accrued and meta-analysis intended.

Fourteen of 675 articles were eligible; 1,226 patients. Only three (21 %) accrued patients prospectively. Twelve (86 %) studies described CT features. Follow-up varied widely; 1 month to 8 years. Prevalence of MP was influenced by accrual: 0.2 % for keyword search versus 1.7 % for consecutive series. Accrual bias affected nine (64 %) studies. 458 (38 %) of 1,209 patients had malignancy at accrual but varied widely (8–89 %), preventing meta-analysis. Sixty (6.4 %) of 933 patients developed new malignancy subsequently, also varying widely (0–11 %). Of just four studies that determined the proportion of unselected, consecutive patients with MP developing subsequent malignancy, three were retrospective and the fourth excluded patients with lymphadenopathy, likely excluding patients with MP.

Studies were heterogeneous, with biased accrual. No available study can determine an association between MP and subsequent malignancy with certainty.

• Our systematic review of mesenteric panniculitis found that imaging studies were biased.

• Spectrum and recruitment bias was largely due to retrospective study designs.

• No study could confirm a certain link between mesenteric panniculitis and subsequent malignancy.

• Excessive methodological heterogeneity precluded meaningful meta-analysis.

• High-quality research linking mesenteric panniculitis imaging features and subsequent malignancy is needed.

• Computed tomography, spiral
• Helical computed tomography
• Panniculitis
• Panniculitis, peritoneal
• Sclerosing mesenteritis

We report the first case of acute Vibrio cholerae infection with computed tomography (CT) changes consistent with mesenteric panniculitis (MP). A 78-year-old Indian man returned from overseas travel with progressively severe nausea, vomiting, abdominal pain, and watery diarrhea. His stool tested positive twice for Vibrio cholerae. CT revealed prominent lymph nodes and a hazy mesentery consistent with MP. Antibiotic treatment resulted in complete resolution of MP on follow-up CT 8 months later. In the setting of Vibrio cholerae infection, the CT finding of MP appears to be the result of a immunologically mediated reactive inflammatory disorder of the mesentery.

Mesenteric panniculitis is a chronic inflammatory process involving the adipose tissue of the mesentery. The etiology is unknown, and it is rare in children. We report a 5 year old girl who presented with abdominal symptoms and was misdiagnosed as appendicular mass. The correct diagnosis was established after surgical resection.