Mesenteric Panniculitis and Associated Disorders

Mesenteric panniculitis is a rare, idiopathic inflammatory condition targeting the adipose tissue of the small‐bowel mesentery. It forms part of a spectrum that ranges from predominantly inflammatory fat necrosis to advanced fibrotic retraction, sometimes referred to as sclerosing mesenteritis or retractile mesenteritis. Clinically, patients may present with non-specific abdominal pain, bloating, nausea or features of bowel obstruction. Radiological assessment, primarily via contrast-enhanced computed tomography, reveals characteristic findings such as a hyperattenuating mesenteric mass, small soft-tissue nodules and a surrounding fatty halo or pseudocapsule. While many cases follow a benign and self-limiting course, a subset progresses to fibrosis with tethering of mesenteric structures, necessitating immunomodulatory therapy or, rarely, surgical intervention. Associations with prior abdominal surgery, gallbladder disease and, less consistently, underlying malignancy have been reported. The pathogenesis remains poorly defined but is thought to involve an aberrant immune response, leading to chronic inflammation, fat necrosis and variable degrees of fibrosis. Treatment options are empirical and include corticosteroids, immunosuppressants such as tamoxifen or azathioprine, and nutritional support. Greater awareness of this disorder is essential to avoid misdiagnosis, to guide appropriate imaging follow-up and to tailor therapeutic strategies according to disease activity and severity.

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Mesenteric Panniculitis and Associated Disorders publication trend

The graph below shows the total number of articles in mesenteric panniculitis and associated disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Mesentery: A continuous fold of peritoneum that suspends the intestines from the posterior abdominal wall, containing blood vessels, lymphatics and fat.

Mesenteric panniculitis: A chronic inflammatory disorder of mesenteric adipose tissue characterised by fat necrosis, inflammation and variable fibrosis.

Sclerosing mesenteritis: The fibrotic end of the mesenteric panniculitis spectrum, marked by dense collagen deposition and retraction of mesenteric structures.

Retractile mesenteritis: A term often used interchangeably with sclerosing mesenteritis to denote predominant fibrotic change leading to mesenteric distortion.

Computed tomography (CT): A cross-sectional imaging technique that uses X-rays and computer processing to visualise internal organs and detect characteristic features of mesenteric inflammation.

Fat necrosis: Death of adipose cells within the mesentery, often accompanied by inflammatory cell infiltration and formation of lipid-laden macrophages.

Fibrosis: Excessive deposition of collagen and extracellular matrix by activated fibroblasts, leading to tissue stiffening and potential structural distortion.

References

1. Mesenteric panniculitis part 1: mdct - pictorial review. Journal of the Belgian Society of Radiology (2011).
2. Sclerosing Mesenteritis: Diverse clinical presentations and dissimilar treatment options. A case series and review of the literature. International Archives of Medicine (2011).
3. Treatment of Sclerosing Mesenteritis with Corticosteroids and Azathioprine. Canadian Journal of Gastroenterology and Hepatology (2001).
4. A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People’s Hospital in China. BMC Gastroenterology (2024).
5. A clinician’s perspective on the new organ mesentery and non-vascular mesenteropathies. Frontiers in Physiology (2024).
6. A Single Tertiary Center 14-year Experience With Mesenteric Panniculitis in Turkey: A Retrospective Study of 716 Patients. The Turkish Journal of Gastroenterology (2023).