Mesenteric panniculitis resulting in bowel obstruction: response to steroids

Two patients with mesenteric panniculitis are presented. The first developed obstruction of the sigmoid colon requiring a decompressing proximal sigmoid end-colostomy; the second presented with an incomplete small bowel obstruction. A convincing, immediate, symptomatic response to steroids was noted in both patients. The first patients responded to such an extent that closure of the colostomy was possible some 10 months later. It would appear that active subacute mesenteric panniculitis, as evidenced by continuing fever, high erythrocyte sedimentation rate and predominance of inflammatory cells with only minimal fibrosis on histologic section, is likely to respond favourably to steroid treatment. Review of the surgical literature indicates that, once the condition has progressed to established fibrosis, steroid treatment is probably ineffectual.