Abstract
IntroductionMesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death.Case presentationA 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The patient underwent an exploratory laparotomy based on the finding of mesenteric soft-tissue density on computed tomography. The laparotomy did not prove to be of any diagnostic or therapeutic value. Upon review of the pre-operative computed tomographic scan at our institution, a diagnosis of mesenteric panniculitis was made. An acceptable resolution of abdominal pain and pedal edema was attained after a 4-week trial of immunosuppressive therapy. This is the first reported case of mesenteric panniculitis with pedal edema as part of its presentation.ConclusionAn increased awareness may lead to the development of a less invasive diagnostic approach and optimal treatment for this rarely recognized condition.
Highlights
Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery
The patient underwent an exploratory laparotomy based on the finding of mesenteric soft-tissue density on computed tomography
An increased awareness may lead to the development of a less invasive diagnostic approach and optimal treatment for this rarely recognized condition
Summary
Mesenteric panniculitis (MP) is a rare inflammatory and fibrosing disorder of unknown etiology involving adipose tissue of the mesentery [1,2,3,4,5]. The patient complained of bilateral dependent pedal edema that started 1 month after the onset of abdominal symptoms. He reported occasional nausea but did not divulge any history of vomiting, altered bowel habits, malaise, fever or weight loss. PpsFparigaetnir-uneoiinrcpgetuedlor1iteafimtsmi;voseonsaesftbtnrdtaieostrsimniucgienvcadehlesacsnroesalmisctytp(e/gmurrtiesaeytsdiscatr(foraeomsawtteo)urgrisrekas)poahnfydmscreaesnleantoitvfeetrhice Pre-operative abdominal computed tomography scan of the patient demonstrating characteristic features of mesenteric panniculitis; soft tissue density/ mass (asterisk) and relative sparing of mesenteric vessels (grey arrow). PpmFariegetnsi-uneeoinrncpetuteedlr2irteayimts'i;v(osweonhasfitbtredtaiosatsirmnurogienwcad)hleacnrosamictytpe/murtisaetsdisct(foaemsatteourgrisrekas)poahnfydmsc'emasneisnottyfetrhice Pre-operative abdominal computed tomography scan of the patient demonstrating characteristic features of mesenteric panniculitis; soft tissue density/ mass (asterisk) and 'misty mesentery' (white arrow). FPpstarirgetnai-unenoinrdcpetiuendlrg3iteaiotmsi;fvo'etmnhaseisbttrmdyaoetmimsneginscetarhnlyatcro(yaam'crrt(poweuwrhtihisettediacadtrfo)ermoawtou)grarenaspdohwfymhsocearsnleinnogtf/etrhice Pre-operative abdominal computed tomography scan of the patient demonstrating characteristic features of mesenteric panniculitis; 'misty mesentry' (white arrow) and whorling/stranding of the mesentry (arrowhead).
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