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Updated: Mar 14, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Crohn's disease mistaken for long-standing idiopathic mesenteric panniculitis: A case report and management algorithm
Alexandre Nuzzo1, Magaly Zappa, Dominique Cazals-Hatem
1aDepartment of Gastroenterology, IBD and Nutritional Support bDepartment of Radiology cDepartment of Histopathology, Beaujon Hospital, Paris 7 University, Paris, France.
Background:
Mesenteric panniculitis (MP) is mostly an associated sign of an intra-abdominal or systemic inflammatory primary disease. Nevertheless, etiological and differential diagnosis of idiopathic MP can be challenging when an associate primary cause is not in the foreground.
Methods:
We report here the case of an isolated small bowel Crohn's disease, long time considered as idiopathic MP.
Results:
This patient presented to our department with a 10-year history of acute abdominal symptoms evolving with flare-up and remission. A diagnosis of idiopathic MP was made based on compatible CT-scan features along with normal laboratory tests and upper and lower bowel endoscopies. As symptoms recurred, a steroid course was proposed which dramatically improved his condition for years. Finally, an explorative laparoscopy was performed because of concern of malignancy when he returned to our unit with a steroid refractory flare-up and weight loss, along with MP nodes growing up to 10 mm. Crohn's disease was eventually diagnosed, based on histopathological middle-gut bowel resection and numerous granulomas in mesenteric nodes without necrosis.
Conclusion:
This case emphasizes the importance of excluding inflammatory intestinal lesions before making the diagnosis of idiopathic MP (fecal calprotectin, magnetic resonance enterography, wireless capsule endoscopy).
Insights
Idiopathic mesenteric panniculitis (MP) can be challenging to diagnose. This case highlights the importance of ruling out inflammatory bowel disease, such as Crohn's disease, before diagnosing idiopathic MP.
Area of Science:
- Gastroenterology
- Abdominal Imaging
- Surgical Pathology
Background:
- Mesenteric panniculitis (MP) is often secondary to other conditions, making idiopathic diagnoses difficult.
- Differentiating idiopathic MP from other intra-abdominal pathologies requires careful evaluation.
Observation:
- A patient with a decade-long history of abdominal symptoms initially diagnosed with idiopathic MP.
- Initial CT scans and endoscopic evaluations were inconclusive for primary causes.
- The patient experienced symptom recurrence and steroid dependence, prompting further investigation.
Findings:
- Histopathological analysis after laparoscopy revealed Crohn's disease with mesenteric lymph node granulomas.
- The patient presented with steroid-refractory flare-ups and weight loss.
- Mesenteric nodes enlarged up to 10mm.
Implications:
- This case underscores the necessity of excluding inflammatory bowel diseases before diagnosing idiopathic MP.
- Advanced diagnostic tools like fecal calprotectin, MRI enterography, and capsule endoscopy are crucial.
- Early and accurate diagnosis is vital for appropriate patient management and treatment.
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