Mesenteric panniculitis in Merseyside: a case series and a review of the literature

Abstract

Mesenteric panniculitis (also known as mesenteric manifestation of Weber–Christian disease, isolated lipodystrophy and mesenteric lipogranuloma), a benign inflammatory or fibrotic change in the mesentery of the bowel, is a rare diagnosis, particularly in the UK. Some 213 cases have been reported in the world-wide literature, just six from the UK. We present four cases of mesenteric panniculitis in Merseyside and review the literature surrounding this poorly understood phenomenon. Four patients who attended surgical out-patients with vague abdominal symptoms, and in two cases a palpable mass, were sent for abdominal computed tomography (CT) scan. One patient was admitted as an emergency with abdominal pain. In each patient there were clear signs of mesenteric panniculitis, first described in 1924. The ’classical’ signs of mesenteric panniculitis seen on CT have been argued by some to be pathognemonic of the disease. In two cases, the patients underwent laparoscopic biopsies to confirm the diagnosis. We discuss the literature relating to mesenteric panniculitis, theories about its aetiology, confirmation of the diagnosis and consider the possibility that it is not actually as rare as we think. We suggest that it is rather under diagnosed due to the relative ignorance of the condition amongst both surgeons and radiologists the UK compared to the US, where mesenteric panniculitis is far more widely reported.