S3576 Mesenteric Panniculitis: Case Report and Literature Review

Abstract

INTRODUCTION: Mesenteric panniculitis, also known as sclerosing mesenteritis, belongs to a spectrum of rare diseases of the fatty (adipose) tissue of the mesentery. It is most commonly associated with abdominal surgery, autoimmune disorders and malignancy. Here we present a rare case of mesenteric panniculitis in a young woman who recently diagnosed with mesenteric panniculitis with no predisposing factors. CASE DESCRIPTION/METHODS: The patient is a 29-year-old female with a past medical history of nephrolithiasis who presented to our emergency department (ED) complaining of generalized nausea, fever, and generalized abdominal pain, which was more severe in the right flank region. Notable workup in the ED included a urinalysis with elevated white blood cell count and many bacteria present. The patient was then started on intravenous antibiotics and was admitted under impression of urinary tract infection. Upon admission a computed tomography (CT) scan of the abdomen was done which showed non-obstructing calculi in the lower pole of the right kidney. Additionally it showed lower abdominal mesenteric fat stranding consistent with mesenteric panniculitis (Figure 1, 2). These findings were most prominent in the lower abdomen and pelvis. The gastroenterology service was consulted and recommended no treatment given the patients abdominal pain being attributed to nephrolithiasis. During her hospitalization the patients abdominal pain resolved with intravenous fluid hydration and antibiotics. She was then discharged home with follow up appointments scheduled. DISCUSSION: Mesenteric panniculitis is a chronic and benign condition caused by fat degeneration and necrosis within mesentery. The exact mechanism of pathogenesis is not clear but a non-specific immune response to various stimuli has been suggested to trigger the inflammation of the adipose tissue. The disease has been associated with inflammatory conditions, autoimmune disorders, malignancies, tuberculosis and abdominal trauma or surgery. Patients can have a variety of symptoms including abdominal pain, nausea, vomiting, diarrhea, constipation, or intestinal obstruction. The main goal of treatment is the relief of symptoms by addressing inflammation. Corticosteroids are the treatment of choice, but colchicine, azathioprine, cyclophosphamide, infliximab have shown success. This case is unique as patient did not have any contributing factors such as abdominal surgeries, autoimmune disorders, family history of auto immune diseases and malignancy.Figure 1.: CT scan (axial view) showing omental fat stranding consistent with mesenteric panniculitis (blue arrow).Figure 2.: CT scan (coronal view) showing omental fat stranding consistent with mesenteric panniculitis (blue arrow).