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Sclerosing mesenteritis and mesenteric panniculitis - clinical experience and radiological features

Lisa Nyberg¹, Jan Björk², Peter Björkdahl³

¹Department of Medicine, Division of Gastroenterology, Hospital of Trelleborg, Trelleborg, Sweden. adolfssonlisa@hotmail.com.

BMC Gastroenterology

|June 15, 2017

Abstract

Background:

Sclerosing mesenteritis (SM) is sometimes used as an umbrella-term for idiopathic inflammatory conditions in the mesentery. Mesenteric panniculitis (MP) is a radiological finding and its relation to clinical SM is not fully understood. The aims of this study were to determine whether any correlation could be found between the radiological findings and the clinical disease course.

Methods:

Patients observed due to idiopathic inflammation of the mesentery were identified. If SM could be verified histologically or MP radiologically, the patients were included in this descriptive retro perspective study.

Results:

Typical radiological changes were observed in 27 patients. A majority (23/27) of these patients had mild to moderate symptoms. This group with typical radiology was labelled MP. Four patients were included due to histologically verified disease but had uncharacteristic radiology involving multiple compartments of the abdomen. All four had marked systemic inflammation, fever and fluctuating radiologic findings. Three had severe disease with multiple hospitalisations and complications but responded promptly to corticosteroids. This group was denoted SM.

Conclusions:

We have identified two subgroups of patients; firstly, MP with stable and characteristic radiologic changes and secondly SM with atypical radiology and a more aggressive clinical course. We propose that the term SM should be reserved for this latter condition.

Insights

Sclerosing mesenteritis (SM) and mesenteric panniculitis (MP) are distinct conditions. MP shows stable radiology with mild symptoms, while SM presents with atypical radiology and a more aggressive clinical course.

Area of Science:

Gastroenterology
Radiology
Pathology

Background:

Sclerosing mesenteritis (SM) is an umbrella term for idiopathic mesenteric inflammatory conditions.
Mesenteric panniculitis (MP) is a radiological finding with an unclear relationship to clinical SM.
The study aimed to correlate radiological findings with the clinical disease course of SM and MP.

Purpose of the Study:

To differentiate between mesenteric panniculitis (MP) and sclerosing mesenteritis (SM).
To investigate the relationship between radiological findings and clinical presentation in these conditions.
To propose a refined classification for these mesenteric inflammatory diseases.

Main Methods:

Retrospective descriptive study of patients with idiopathic mesenteric inflammation.
Inclusion criteria: histological verification of SM or radiological evidence of MP.
Analysis of radiological findings, clinical symptoms, and disease course.

Main Results:

Two patient subgroups were identified based on radiological and clinical features.
Mesenteric panniculitis (MP) group (23/27 patients) exhibited typical radiology and mild-to-moderate symptoms.
Sclerosing mesenteritis (SM) group (4 patients) showed atypical radiology, systemic inflammation, and a more severe clinical course, responding to corticosteroids.

Conclusions:

Mesenteric panniculitis (MP) is characterized by stable, typical radiological changes and a milder course.
Sclerosing mesenteritis (SM) is associated with atypical radiology, aggressive clinical behavior, and systemic inflammation.
The term sclerosing mesenteritis (SM) should be reserved for the aggressive subgroup with atypical radiological findings.

Read full analysis

Keywords:

Clinical classification Mesenteric panniculitis Mesenteritis Panniculitis Radiological classification Retractile mesenteritis Sclerosing mesenteritis

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