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Suggest Treatment For Mesenteric Panniculitis

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Posted on Mon, 1 Dec 2014
Question: Hi I'm XXXX I've just had ct scan for kidney stone and while there was told radiographer had spotted something else nodules in bowel he said these could be ok but are sometimes a pre cursor to other things and to monitor them ie have another scan in 6 months then I remembered when I had a ct scan back in 2002 for abdominal the consultant said everything was ok but there was nodules all 5. Mm in size mesentry in small bowel he said they prob ok as some people have diff size nodules and that I get ct 3 months later which then he said they were ok can u help me on this the recent radiographer ref to them as mesentry panniculitus do these two episodes sound the same thanks XXXX
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
Not a concern if you have no associated symptoms.

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Mesenteric panniculitis is a rare autoimmune condition with the exact cause remaining unknown. Research has shown a strong relationship between tobacco use and mesenteric panniculitis. This condition can become chronic and findings exist for years with similar and stable findings on CT scan.

It mainly appears as an inflammation of the fat attached to the intestines and the symptoms vary with each patient and may include abdominal tenderness, anorexia, abdominal pain, abdominal fullness, nausea, fever, and weight loss.

Ultrasounds and CT scans are the most common imaging tests showing a thickening of the mesentery (fat attached to intestines). Nodules might be seen in some patients. Punctate and coarse calcifications as well as small lymph nodes (usually <5 mm) may be present within the region. Often biopsy or open surgery is required to make a confirmed diagnosis only in symptomatic patients.

The condition can be said to occur in 3 stages as per the nature of cells found at biopsy.
The first stage is mesenteric lipodystrophy shows altered fat tissue.
The second stage, termed mesenteric panniculitis shows build up of certain types of white blood cells and is accompanied with symptoms like fever, abdominal pain and weakness.
The third stage is retractile mesenteritis and cells show collagen deposition, fibrosis, and inflammation.

Mesenteric panniculitis resolves spontaneously in most cases, however, palpable masses may often be found between 2 and 11 years after diagnosis, especially in patients with associated problems. In such cases, several types of treatment have been proposed but no consensus has been established.

If there is no progress from the CT findings in 2002 then the condition has not progressed. The progression of mesenteric panniculitis is unique in every patient and for 5 mm nodules there is no concern in the absence of any disturbing symptoms.

If the nodules have remained the same in size and location since 2002 then there is no need of a repeat CT scan after 3 months. However, should you develop symptoms of recent onset and there are other findings like mesenteric fat changes and any suspicious soft tissue masses then a follow up CT scan might be done after discussing with your doctor.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6874 Questions

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Suggest Treatment For Mesenteric Panniculitis

Brief Answer: Not a concern if you have no associated symptoms. Detailed Answer: Hi XXXX, Thanks for writing in to us. I have read through your query in detail. Mesenteric panniculitis is a rare autoimmune condition with the exact cause remaining unknown. Research has shown a strong relationship between tobacco use and mesenteric panniculitis. This condition can become chronic and findings exist for years with similar and stable findings on CT scan. It mainly appears as an inflammation of the fat attached to the intestines and the symptoms vary with each patient and may include abdominal tenderness, anorexia, abdominal pain, abdominal fullness, nausea, fever, and weight loss. Ultrasounds and CT scans are the most common imaging tests showing a thickening of the mesentery (fat attached to intestines). Nodules might be seen in some patients. Punctate and coarse calcifications as well as small lymph nodes (usually <5 mm) may be present within the region. Often biopsy or open surgery is required to make a confirmed diagnosis only in symptomatic patients. The condition can be said to occur in 3 stages as per the nature of cells found at biopsy. The first stage is mesenteric lipodystrophy shows altered fat tissue. The second stage, termed mesenteric panniculitis shows build up of certain types of white blood cells and is accompanied with symptoms like fever, abdominal pain and weakness. The third stage is retractile mesenteritis and cells show collagen deposition, fibrosis, and inflammation. Mesenteric panniculitis resolves spontaneously in most cases, however, palpable masses may often be found between 2 and 11 years after diagnosis, especially in patients with associated problems. In such cases, several types of treatment have been proposed but no consensus has been established. If there is no progress from the CT findings in 2002 then the condition has not progressed. The progression of mesenteric panniculitis is unique in every patient and for 5 mm nodules there is no concern in the absence of any disturbing symptoms. If the nodules have remained the same in size and location since 2002 then there is no need of a repeat CT scan after 3 months. However, should you develop symptoms of recent onset and there are other findings like mesenteric fat changes and any suspicious soft tissue masses then a follow up CT scan might be done after discussing with your doctor. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek