What Lies Beneath: A Case of Mesenteric Panniculitis Masquerading as Recurrent Acute Pancreatitis

Abstract

Introduction: Mesenteric panniculitis is a rare inflammatory condition characterized by chronic and nonspecific inflammation of the adipose tissue of the intestinal mesentery. Here, we describe a case of mesenteric panniculitis in a patient with recurrent pancreatitis presenting with abdominal pain. To our knowledge, there is scant available literature regarding the association of mesenteric panniculitis and recurrent acute pancreatitis. Case Presentation: A 27-year-old female with past medical history of familial hypertriglyceridemia and recurrent acute pancreatitis presented with a 3-day history of severe epigastric abdominal pain radiating to her upper back with intermittent bilious vomiting. On admission her lipase level was within normal limits and triglyceride level was 1,500 mg/dL. A right upper quadrant ultrasound revealed mild gallbladder wall thickening. Computed tomography scan of the abdomen with IV contrast showed no clear signs of pancreatitis. However, it demonstrated mild stranding of the mesenteric root with several prominent lymph nodes consistent with mesenteric panniculitis (figure 1). During hospitalization her autoimmune workup was negative with IgG subclasses within normal limits. An EGD was performed and only notable for mild duodenitis. The patient had resolution of her symptoms with IV fluid hydration and PPI therapy, and she was discharged on optimal hypertriglyceride therapy.Figure 1Discussion: Mesenteric panniculitis is a rare condition. There is currently a paucity of data regarding this condition. The etiology of this disease remains unknown but has been associated with abdominal trauma, abdominal surgery, infection, autoimmune diseases, paraneoplastic syndromes, or ischemic processes. This case highlights the critical importance of early recognition in order mitigate the possibility of poor outcomes. It is crucial for gastroenterologists to be aware of such etiologies of abdominal pain when evaluating patient who present with otherwise typical symptoms presumptive of pancreatitis.