Postgrad Med J: first published as 10.1136/pgmj.56.651.67 on 1 January 1980. Downloaded from

Postgraduate Medical Journal (January 1980) 56, 67-68

Mesenteric M. C. ORMISTON H. THOMSON F.R.C.S. M.S., F.R.C.S. Gloucester Royal Hospital, Great Western Road, Gloucester

Summary Discussion A case of mesenteric panniculitis is presented, with a Mesenteric panniculitis is a rare condition usually review of previous reports. affecting the middle-aged. Presenting features may include abdominal or back pain, a mass, vomiting, bowel disturbance, passage of blood per rectum and Introduction pyrexia (Ogden, Bradburn and Rives, 1965; Durst et Mesenteric panniculitis is a rare cause of pyrexia, al., 1977). abdominal pain, and an intra-abdominal mass. Investigations are often normal and are of no diagnostic help. Pathological findings range from lumpy thickening Case report of the ileal mesentery, which has yellowish dis- A 31-year-old lorry driver was admitted with a coloured patches and microscopic infiltration of the 2-week history of , anorexia, and pain in the fat by lymphocytes, macrophages, and foreign body by copyright. right loin. He looked ill, was pyrexial, and was giant cells, to a retracted, scarred, and adherent tender in his right renal angle and right calf. There mesentery with fat necrosis, fibrosis, and calcifica- were no other physical signs. A provisional diagnosis tion (Ogden et al., 1965). The disease is generally of renal disease, possibly associated with a deep vein confined to the small bowel mesentery, but can thrombosis, was made. However, an IVP and MSU involve retroperitoneal structures and the sigmoid were normal. mesocolon (Durst et al., 1977). Investigations, including screens for occult car- This condition has been described as retractile cinoma, auto-immune disease, , and bone mesenteritis, which represents an advanced stage of were all the marrow disorders, unremarkable except the disease with scarring and fibrosis (Soergel and http://pmj.bmj.com/ ESR which was 124 mm/hr. One month after Hensley, 1966), and also mesenteric manifestations admission he developed a few subcutaneous nodules of Weber Christian disease (Herrington, Edwards on his arms, of which showed non-specific and Grossman, 1961), the characteristic sub- fibrosis. Four weeks later the patient was still unwell cutaneous nodules of inflamed found and complained of increasingly severe back-ache. A in Weber Christian disease being absent. Foci of fat diagnostic laparotomy was performed 3 months after in the retroperitoneal, pericardial and presentation. A number of abnormalities were found. mediastinal tissues in Weber Christian disease are

The folds of the mesentery were stuck together by occasionally reported post mortem (Steinberg, 1953; on September 25, 2021 by guest. Protected flimsy vascular adhesions and fibrin. Similar Milner and Mitchinson, 1965). However, the course adhesions were present between the and of mesenteric panniculitis is usually benign (Ogden diaphragm. The base of the ileal mesentery was et al., 1965; Durst et al., 1977). greatly thickened and contained enlarged rubbery The aetiology of mesenteric panniculitis is un- nodules which, on section, revealed a variegated known. A wide variety of other conditions have yellow appearance. Lymph nodes, liver and peri- occasionally been found in association. toneal specimens were taken for histology and Surgical intervention is generally confined to culture. Histology showed active fibrosis of the laparotomy and biopsy. By-pass or resection of peritoneum but no specific features. The lymphoid obstructed bowel may be required. Steroids are said histiocytes contained finely divided fat, an appear- to afford symptomatic relief in some instances. ance consistent with lymph nodes draining an area The presentation of this patient was not atypical, of active fat inflammation and necrosis. The liver except that his ESR was remarkably high. However, biopsy showed a non-specific increase of inflam- he did not respond to prednisone and remains ill and matory cells. Culture for organisms including tuber- in pain 15 months after laparotomy. The sub- culosis was negative. cutaneous nodules are of interest in view of the 0032-5473/80/0100-0067 $02.00 © 1980 The Fellowship of Postgraduate Medicine Postgrad Med J: first published as 10.1136/pgmj.56.651.67 on 1 January 1980. Downloaded from

68 Case reports comparisons drawn between mesenteric pannicu- References litis and Weber Christian disease. Whether or not DURST, A.L., FREUND, H., ROSENMANN, E. & BIRNBAUM, D. the 2 conditions are of the same under- (1977) Mesenteric panniculitis: Review of literature and expressions presentation of cases. Surgery, 81, 203. lying pathological process is uncertain. The outlook HERRINGTON, J.L., EDWARDS, W.H. & GROSSMAN, L.A. for patients with fat inflammation apparently (1961) Mesenteric manifestations of Weber Christian confined to the or ileal mesen- disease. Annals of Surgery, 154, 949. MILNER, R.D.G. & MITCHINSON, M.J. (1965) Systemic Weber tery is good, but there is evidence that more wide- Christian disease. Journal of Clinical Pathology, 118, 150. spread disease is associated with a considerable OGDEN, W.W., BRADBURN, D.M. & RIVES, J.D. (1965) increase in morbidity and mortality. Mesenteric panniculitis. Annals of Surgery, 161 864 SOERGEL, K.H. & HENSLEY, G.T. (1966) Fatal mesenteric Acknowledgments panniculitis. Gastroenterology, 51, 529. The authors wish to thank Anne Stinchcombe for typing STEINBERG, B. (1953) Systemic nodular panniculitis. American the manuscript. Journal of Pathology, 29, 1059. by copyright. http://pmj.bmj.com/ on September 25, 2021 by guest. Protected