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Updated: Aug 15, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
[Mesenteric panniculitis]
G Piessen1, C Mariette, J-P Triboulet
1Service de Chirurgie Digestive et Générale, Hôpital Claude-Huriez, CHU, place de Verdun 59037, Lille cedex, France.
Abstract:
Mesenteric panniculitis also named retractile mesenterite is a rare tumor-like lesion that thickens and shortens the mesentery. It is characterized by the association of inflammation, necrosis or fibrosis involving the adipose tissue of the bowel mesentery. The pathophysiology of this disease remains unclear despite associations with inflammatory diseases or malignancies, especially lymphomas that have been described. When symptomatic, patients may present with abdominal pain, palpable abdominal mass or intestinal obstruction. The disease remains asymptomatic in 30 to 50% of cases. Abdominal CT plays an important role in suggesting the diagnosis and can be useful in distinguishing the several conditions that can mimic mesenteric panniculitis. Nevertheless, pathologic examination of surgical excisional biopsies or sometimes percutaneous biopsies remains necessary to confirm the diagnosis and exclude an underlying infection or malignancy. Medical treatment may consist of therapy with anti inflammatory or immunosuppressive agents and can be proposed in highly symptomatic diseases. Surgical treatment should be exclusively attempted when intestinal obstruction or ischemia occur. Most of the time, it consists in intestinal derivation or segmental resection because complete excision of the lesions is often not possible. Mesenteric panniculitis usually has an uneventful clinical course and resolves spontaneously in a variable delay.
Insights
Mesenteric panniculitis is a rare condition affecting the bowel mesentery, causing thickening and shortening. While often asymptomatic, it can present with abdominal pain or obstruction, requiring diagnosis via imaging and biopsy.
Area of Science:
- Gastroenterology
- Pathology
- Radiology
Context:
- Mesenteric panniculitis, or retractile mesenteritis, is a rare, tumor-like lesion impacting the bowel mesentery.
- It involves inflammation, necrosis, or fibrosis of mesenteric adipose tissue, with unclear pathophysiology.
- Associations with inflammatory diseases and malignancies, particularly lymphomas, have been noted.
Purpose:
- To review the clinical presentation, diagnostic modalities, and management strategies for mesenteric panniculitis.
- To highlight the role of imaging and histopathology in diagnosis and differential diagnosis.
- To discuss current treatment approaches and the typical clinical course.
Summary:
- Mesenteric panniculitis presents as mesenteric thickening and shortening, characterized by inflammation and fibrosis of adipose tissue.
- Diagnosis relies on imaging (CT) and pathological examination of biopsies to rule out mimics like infection or malignancy.
- Management includes anti-inflammatory/immunosuppressive agents for symptomatic cases and surgery for obstruction/ischemia, with a generally favorable prognosis.
Impact:
- Provides a comprehensive overview of mesenteric panniculitis for clinicians.
- Emphasizes the importance of accurate diagnosis to guide appropriate patient management.
- Contributes to understanding the clinical course and outcomes of this rare mesenteric disease.
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