What Is Mesenteric Panniculitis and How Is It Treated?

Mesenteric panniculitis is a rare disease that affects the part of the mesentery that contains fat cells.

The mesentery is a continuous fold of tissue in your abdomen. You might not have heard of it before, but it’s important because it supports your intestines and attaches them to the abdominal wall of your body.

The specific cause of mesenteric panniculitis isn’t known, but may be related to autoimmune disease, abdominal surgery, injury to your abdomen, bacterial infection, or vascular problems. It causes chronic inflammation that damages and destroys fatty tissue in the mesentery. Over time, this can lead to scarring on the mesentery.

You might hear your doctor call mesenteric panniculitis by a different name, such as sclerosing mesenteritis. Some medical professionals use the following to describe the stages of the condition:

• Mesenteric lipodystrophy is the first stage. A type of immune system cell replaces fat tissue in the mesentery.
• Mesenteric panniculitis is the second stage. Additional types of immune system cells infiltrate the mesentery, and a lot of inflammation occurs during this stage.
• Retractile mesenteritis is the third stage. It’s when the inflammation is accompanied by scar tissue formation in the mesentery.

Mesenteric panniculitis typically isn’t life-threatening. It may go away on its own, or it could develop into a severe disease. But while the inflammation is there, it can cause pain and other symptoms that interfere with your life. Your doctor can give you medicine to manage this inflammation and control symptoms.

Keep reading to learn more.

Symptoms vary from person to person. The clinical course may vary from no symptoms to severe and aggressive disease.

If there’s enough inflammation in the mesentery, the swelling can put pressure on organs near your intestines. This pressure can cause abdominal pain.

Other common symptoms include:

• nausea
• vomiting
• diarrhea
• constipation
• feeling full quickly after you eat
• loss of appetite
• weight loss
• bloating
• lump in your abdomen
• fatigue
• fever

Symptoms can last for a few weeks or months, and then go away.

Although the exact cause isn’t known, doctors think mesenteric panniculitis is possibly a type of autoimmune disease.

Normally, your immune system fights off bacteria, viruses, and other germs that can make you sick. In an autoimmune disease, your immune system mistakenly attacks your body’s own tissues. In this case, it attacks the mesentery. This attack produces the inflammation that causes symptoms.

Autoimmune diseases have been linked to genes that run in families. People with mesenteric panniculitis often have a parent, sibling, or other relative with an autoimmune disease like rheumatoid arthritis or Crohn’s disease.

This disease is rare overall, but it’s twice as common in men as in women.

Inflammation may be triggered by damage to the abdomen, which can be caused by:

• infection
• surgery
• some medicines
• injuries

Cancer can also cause the mesentery to become inflamed and thickened. Mesenteric panniculitis may affect people with these cancers:

• lymphoma
• carcinoid tumors
• colon cancer
• kidney cancer
• prostate cancer
• melanoma
• lung cancer
• stomach cancer

Other conditions that are related to mesenteric panniculitis include:

• orbital pseudotumor, which causes inflammation and swelling in the hollow space around and behind the eye
• Riedel thyroiditis, which causes scar tissue to form in and around the thyroid gland
• retroperitoneal fibrosis, which causes fibrous scar tissue to build up around organs located behind the membrane that lines and surrounds other organs in the front of your abdomen
• sclerosing cholangitis, an inflammatory disease that causes scars to form in the bile ducts of your liver

Mesenteric panniculitis is often misdiagnosed because it’s so rare.

Sometimes doctors discover the disease incidentally when they do a CT scan to look for the cause of abdominal pain. This test can detect any signs of thickening or scarring in your mesentery.

To make a diagnosis, your doctor may also have you undergo one or more blood tests to look for markers of inflammation in your body. This includes checking your erythrocyte sedimentation rate and C-reactive protein level.

Your doctor may perform a biopsy to confirm the diagnosis. In this test, your doctor removes a sample of tissue from your mesentery and sends it to a lab to be examined.

People with mesenteric panniculitis may not need treatment. Your doctor will monitor your symptoms and may do repeat CT scans to see if the inflammation is getting worse. It’s possible for mesenteric panniculitis will go away on its own within a few weeks or months.

If your symptoms bother you or they cause complications, your doctor will give you medicine to bring down inflammation in your body. Many of the drugs used to treat this condition work by suppressing the overactive immune system response. Corticosteroid drugs are often used to treat mesenteric panniculitis.

Other medicines that treat this condition include:

• azathioprine (Imuran)
• colchicine (Colcrys)
• cyclophosphamide
• infliximab (Remicade)
• naltrexone (Revia) at a low dose
• pentoxifylline
• thalidomide (Thalomid)

Inflammation in the mesentery can sometimes lead to a blockage in your small intestine. This blockage can cause symptoms like nausea, bloating, and pain, and it can prevent your intestines from absorbing nutrients from foods you eat, in addition to decreasing the normal forward movement of substances through your intestines.

In these cases, surgery may be necessary to relieve your symptoms.

Mesenteric panniculitis has also been linked to cancers, like lymphoma, prostate cancer, and kidney cancer. In a 2016 study, 28 percent of people with this condition either already had an associated cancer or were recently diagnosed with it.

Mesenteric panniculitis is chronic, but it usually isn’t serious or life-threatening. However, if your symptoms are severe, they can have a big effect on your quality of life.

Symptoms can last anywhere from a couple of weeks to many years. The average length of time is about six months. Mesenteric panniculitis may even get better on its own.