The medical mystery of the fatty mesentery

An 86-year-old gentleman presented with a 3-month history of nausea, anorexia and excruciating generalised abdominal pain. He had been discharged a week earlier from another hospital. No diagnosis had been made. Clinically the patient was feverish, with a palpable, tender and poorly defined mass in his epigastrium. He had elevated inflammatory markers and deranged electrolytes. An ultrasound scan revealed thickening and hyper echogenicity of the small bowel mesentery. A CT scan was recommended; this revealed a diagnosis of mesenteric panniculitis. First described in 1924, mesenteric panniculitis is a benign inflammatory condition of the bowel mesentery. With only a handful of cases being reported in the UK, the authors thought that they had come across a rarity. This case report focuses on the aetiology, diagnosis, pathology and treatment of mesenteric panniculitis. By examining the literature, the authors also suggest that it is relatively underdiagnosed and may be more common than first thought.