Percutaneous image-guided mesenteric biopsy: how we do it in a high-volume training center

Lesions in the mesentery are unique from other potential biopsy targets in the abdomen or pelvis for several reasons. Mesenteric lesions are among the deepest in the abdomen and are often surrounded by or adjacent to small bowel or colon. Mesenteric vasculature is often crowded, and traversing the mesentery often involves crossing multiple vascular planes. Mesenteric lesions and the structures surrounding them within the peritoneal cavity are often highly mobile. All these features can be daunting to any radiologist asked to perform a mesenteric biopsy. We provide a comprehensive overview and guide to percutaneous mesenteric biopsy informed by available literature and experience at two high volume teaching centers. Topics covered include the pitfalls of using prior imaging to determine whether mesenteric biopsy is possible, techniques specific to US or CT-guidance and complications including hemorrhage and bowel injury.