Mesenteric Panniculitis: Symptoms, Types, Causes and Treatment

Mesenteric panniculitis is a rare but intriguing condition that affects the fatty tissue of the mesentery, the supportive fold attaching the intestines to the abdominal wall. Though often discovered incidentally during imaging for unrelated issues, it can sometimes cause significant discomfort and lead to diagnostic confusion with more serious diseases. In this article, we delve into the symptoms, types, causes, and treatment strategies for mesenteric panniculitis, drawing on the latest research and clinical insights.

Symptoms of Mesenteric Panniculitis

Mesenteric panniculitis (MP) often flies under the radar. Many people have no symptoms at all and only discover the condition accidentally during a CT scan. For those who do experience symptoms, the signs can be vague and easily mistaken for other abdominal problems. Recognizing these symptoms is key to guiding diagnosis and management.

Symptom	Frequency	Clinical Notes	Sources
Abdominal Pain	Common	Often persistent, non-specific	1 2 5 11
Nausea/Vomiting	Occasional	Sometimes with obstructive features	2 5 11
Weight Loss	Less common	Unintentional, gradual	1 4 5
Fever	Rare	Usually low-grade	2 4 11 14
Diarrhea	Rare	Non-specific abdominal upset	2
Fatigue	Occasional	May be associated with inflammation	4 14
Abdominal Mass	Rare	Palpable in advanced cases	1 5

Table 1: Key Symptoms of Mesenteric Panniculitis

Understanding the Symptom Spectrum

Abdominal Pain: The Hallmark

Abdominal pain is the most commonly reported symptom of mesenteric panniculitis, present in up to 90% of symptomatic cases. The pain is typically chronic, dull, and poorly localized. It may be intermittent or persistent and can mimic more common gastrointestinal disorders, making diagnosis challenging 1 2 5 11.

Gastrointestinal Upset: Nausea, Vomiting, and Diarrhea

Some patients experience nausea and vomiting, sometimes accompanied by mild diarrhea. These symptoms are generally non-specific and can be mistaken for a stomach virus or food intolerance. In rare cases, symptoms may suggest partial bowel obstruction if the inflammation is severe 2 5 11.

Systemic Symptoms: Weight Loss, Fever, Fatigue

Unintentional weight loss and low-grade fever are less common but may be seen in more advanced or chronic cases. Fatigue can also be present, particularly if there is ongoing inflammation or associated autoimmune disease 1 4 14.

Palpable Mass and Other Rare Findings

A palpable abdominal mass is an uncommon finding, usually in advanced cases where fibrotic changes have led to a lump or thickening in the mesentery. Additional rare features can include peritoneal irritation and ascites 1 5.

Asymptomatic Presentation

Despite the potential for these symptoms, the majority of people with mesenteric panniculitis are asymptomatic, and the condition is often picked up incidentally on imaging performed for other reasons 2 5 7.

Types of Mesenteric Panniculitis

Not all cases of mesenteric panniculitis are the same. The disease actually represents a spectrum, with different pathological features and clinical implications. Understanding this spectrum helps clinicians choose the right approach for each patient.

Type/Subtype	Features	Distinction	Sources
Mesenteric Panniculitis	Predominant inflammation	Fat necrosis, inflammation, minimal fibrosis	1 3 7 8
Retractile Mesenteritis	Predominant fibrosis	Dense scarring, tissue retraction	1 7 8
Sclerosing Mesenteritis	Histopathological term	Encompasses both above types	3 7
Idiopathic/Secondary	Based on etiology	No clear cause vs. known association	12

Table 2: Types and Subtypes of Mesenteric Panniculitis

A Closer Look at Disease Variants

Mesenteric Panniculitis (MP)

This is the classical form, dominated by inflammation and fat necrosis in the mesenteric tissue. Fibrosis is usually mild, and the disease rarely leads to major complications. Most patients with this form are either asymptomatic or have mild symptoms 1 3 7 8.

Retractile Mesenteritis (RM)

Here, the process shifts toward fibrosis and scarring, causing the tissue to contract and potentially compress adjacent structures. This form is less common but can lead to more significant symptoms, such as bowel obstruction or palpable masses 1 7 8.

Sclerosing Mesenteritis

This is a histological umbrella term that includes both mesenteric panniculitis and retractile mesenteritis. It emphasizes the chronic, fibrosing nature of the disorder 3 7.

Idiopathic vs. Secondary Forms

• Idiopathic MP: No identifiable underlying cause.
• Secondary MP: Occurs in association with other conditions such as cancer, autoimmune disorders, recent abdominal surgery, or trauma 12.

Disease Progression

The spectrum from pure inflammation (MP) to dominant fibrosis (RM) is not necessarily linear, and progression from one to the other is rare 7. Most cases remain stable or even regress spontaneously.

Causes of Mesenteric Panniculitis

Why does mesenteric panniculitis occur? In most cases, the answer remains elusive. However, several potential triggers and risk factors have been identified through clinical observation and research.

Cause/Association	Evidence Level	Clinical Context	Sources
Idiopathic	Common	No clear underlying trigger	3 12
Malignancy	Possible link	Lymphoma, other cancers	2 4 10 12
Autoimmune Disease	Documented cases	Sjögren's, others	4 12
Previous Surgery	Observed	Abdominal procedures	4 8 12
Trauma	Reported	Abdominal injury	3 8 12
Infection	Suspected trigger	Various pathogens	3 4 8
Ischemia	Suspected	Vascular compromise	3
Medications	Rare reports	Certain drugs	3

Table 3: Possible Causes and Associations of Mesenteric Panniculitis

Exploring the Etiological Landscape

Idiopathic Cases: The Rule, Not the Exception

Most cases of mesenteric panniculitis are idiopathic, meaning no clear cause is found. This suggests a possible interplay between genetic susceptibility and environmental triggers 3 12.

Malignancy: Association or Coincidence?

The link between mesenteric panniculitis and cancer—especially lymphoma—has been hotly debated. While some studies suggest an association, others argue that MP is an age-related, non-specific inflammatory phenomenon rather than a true paraneoplastic syndrome. Nonetheless, the possibility of underlying malignancy should be considered, especially in older adults or those with other risk factors 2 10 12.

Autoimmune and Inflammatory Conditions

Several autoimmune diseases, including Sjögren's syndrome, have been reported in association with MP. In such cases, immune-mediated inflammation may target the mesenteric fat 4 12.

Surgical, Traumatic, and Infectious Triggers

Previous abdominal surgery, trauma, or infections are thought to act as local triggers for the inflammatory process in susceptible individuals 3 4 8 12.

Other Factors

Rarely, ischemia (reduced blood flow) or certain medications have been implicated in the development of MP 3.

Takeaway

Despite these associations, a direct causative link is often unproven, and most cases remain idiopathic.

Treatment of Mesenteric Panniculitis

Managing mesenteric panniculitis involves a tailored approach based on symptoms and disease severity. Since many cases are asymptomatic, aggressive treatment is often unnecessary. When symptoms do occur, several therapeutic options are available.

Approach	Indication	Common Agents/Methods	Sources
Observation	Asymptomatic cases	No intervention	2 6 13
NSAIDs/Antibiotics	Mild symptoms	Ibuprofen, antibiotics	12 13
Steroids	Moderate/severe symptoms	Prednisone, methylprednisolone	3 4 6 11 13 14
Immunosuppressants	Refractory cases	Azathioprine, cyclophosphamide	3 6
Tamoxifen/Colchicine/Thalidomide	Special cases	Hormonal agents/anti-inflammatories	3 6 12
Surgery	Obstruction/complications	Resection (rare)	6 13

Table 4: Treatment Strategies for Mesenteric Panniculitis

Strategies for Management

Observation and Reassurance

• Most patients with incidentally discovered, asymptomatic MP require no treatment.
• Regular monitoring and reassurance are generally sufficient, as the condition is often benign and self-limited 2 6 13.

Symptom-Directed Therapy

• Mild to Moderate Symptoms: NSAIDs and antibiotics are often used as first-line therapy for mild inflammatory symptoms. These agents can reduce pain and inflammation effectively in many cases 12 13.
• Corticosteroids: When symptoms are more severe or persistent, corticosteroids such as prednisone or methylprednisolone are the mainstay of treatment. They help control inflammation and often lead to rapid symptom improvement 3 4 6 11 13 14.

Immunosuppressive and Alternative Agents

• For patients with refractory or steroid-dependent disease, immunosuppressive drugs such as azathioprine or cyclophosphamide may be considered.
• Other agents that have shown benefit in case reports include tamoxifen, colchicine, progesterone, and thalidomide. These are typically reserved for difficult cases or when other therapies have failed 3 6 12.

Surgical Intervention

• Surgery is rarely needed but may be required in cases of bowel obstruction, intractable pain, or when malignancy cannot be excluded.
• Surgical approaches are limited to specific complications and are not generally recommended as first-line therapy 6 13.

Prognosis and Follow-Up

• The overall prognosis is favorable, with most symptomatic patients responding well to medical therapy or even experiencing spontaneous remission 1 11 13.
• Close follow-up is important, especially in cases associated with underlying diseases or when symptoms persist.

Conclusion

Mesenteric panniculitis is a fascinating and often under-recognized condition with a wide range of presentations and outcomes. Here’s a recap of the key insights:

• Symptoms are often mild or absent, but can include abdominal pain, nausea, weight loss, fever, and rarely, palpable mass.
• Types range along a spectrum from inflammatory (mesenteric panniculitis) to fibrotic (retractile mesenteritis), with “sclerosing mesenteritis” as a histopathological umbrella term.
• Causes are usually unknown (idiopathic), but potential associations include cancer, autoimmune disease, prior surgery, trauma, and infection.
• Treatment is individualized: Most cases require no intervention, while symptomatic cases often respond to NSAIDs, corticosteroids, or immunosuppressants. Surgery is reserved for rare complications.

Key points at a glance:

• Mesenteric panniculitis is usually benign and self-limiting.
• Diagnosis is often via CT imaging, with characteristic findings.
• Most patients do well with conservative management or simple anti-inflammatory treatments.
• Vigilance for underlying causes or complications is warranted, particularly in symptomatic individuals.

Awareness of mesenteric panniculitis and its varied presentations is essential for clinicians and patients alike, ensuring accurate diagnosis, appropriate care, and peace of mind.