Service de Médecine Interne, Assistance Publique-Hôpitaux de Marseille-AP-HM, Université AIX-MARSEILLE, Hôpital Nord, Chemin des Bourrely, 13915 Marseille Cedex 15, France.
BMC Gastroenterol. 2012 Jun 6;12:59. doi: 10.1186/1471-230X-12-59.
Mesenteric panniculitis is a rare chronic fibrosing inflammatory disease that typically affects the adipose tissue and mesentery of the small intestine but may also affect the mesosigmoid and the mesocolon. The pathology of this disease remains unclear despite association with some malignancies or inflammatory disorders. We report a case of mesocolic panniculitis and a literature review of its clinical presentation, imaging findings, associated conditions and treatment options.
A 64 year-old Caucasian man was admitted to the gastroenterology department for severe weakness, left lower quadrant abdominal pain, weight loss and diarrhoea. Physical examination revealed a palpable firm mass occupying the entire left part of the abdomen. Abdominal CT-scan showed fatty infiltration of the mesosigmoid and left mesocolic fat which was strongly suggestive of panniculitis. Laparoscopic surgery revealed an inflamed and edematous mesocolon and mesosigmoid; the sigmoid mucosa appeared petechial which was suggestive of venous ischemia. Histological examination of surgical biopsies revealed mesocolic panniculitis. Despite exhaustive investigation, no associated conditions were found and the cause was classified as idiopathic. Surprisingly, the patient clinically improved without therapeutic intervention other than supportive care.
Although mesenteric panniculitis is most often a radiographic diagnosis without clinical symptomatology, it can also present with significant general status alteration. We report a case of mesocolic panniculitis complicated by development of an inflammatory mass associated with ischemic colitis. Mesenteric panniculitis is a difficult diagnosis to make which typically requires histologic confirmation. The overall prognosis is good with supportive treatment.
肠系膜脂膜炎是一种罕见的慢性纤维炎性疾病，通常影响小肠的脂肪组织和肠系膜，但也可能影响乙状结肠系膜和结肠系膜。尽管与某些恶性肿瘤或炎症性疾病有关，但该疾病的病理仍然不清楚。我们报告一例结肠系膜脂膜炎，并对其临床表现、影像学表现、相关疾病和治疗选择进行文献复习。
一名 64 岁白人男性因严重虚弱、左下腹腹痛、体重减轻和腹泻而入住消化内科。体格检查发现可触及的坚硬肿块占据整个左腹部。腹部 CT 扫描显示乙状结肠系膜和左结肠系膜脂肪的脂肪浸润，强烈提示脂膜炎。腹腔镜手术显示炎症性和水肿性结肠系膜和乙状结肠系膜；乙状结肠黏膜呈瘀点状，提示静脉缺血。手术活检的组织学检查显示结肠系膜脂膜炎。尽管进行了详尽的调查，但未发现相关疾病，病因被归类为特发性。令人惊讶的是，患者在没有治疗干预（除了支持性护理）的情况下临床状况明显改善。
尽管肠系膜脂膜炎通常是一种无临床症状的影像学诊断，但它也可能表现为明显的全身状态改变。我们报告一例结肠系膜脂膜炎并发炎症性肿块伴缺血性结肠炎。肠系膜脂膜炎的诊断较为困难，通常需要组织学证实。支持性治疗的总体预后良好。
