Wagner Christopher, Dachman Abraham, Ehrenpreis Eli D
Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Department of Radiology, University of Chicago Hospital, Chicago, Illinois.
Clin Colon Rectal Surg. 2022 Aug 10;35(4):342-348. doi: 10.1055/s-0042-1743588. eCollection 2022 Jul.
Mesenteric panniculitis (MP) is the preferred nomenclature for a continuum of inflammatory diseases of the mesentery. The diagnosis of MP is often based on the appearance of a mass-like structure at the root of the mesentery. Characteristic histology includes focal fat necrosis, chronic inflammation, and sometimes mesenteric fibrosis. At present, robust literature related to diagnosis and management of MP are limited. MP is postulated to be an immune-mediated chronic inflammatory and/or a paraneoplastic disease. A personal or family history of other autoimmune diseases is commonly apparent. Several inciting events have been identified that possibly act as triggers in the development of the disease. Trauma, abdominal surgery, infection, and various cancers have been associated with mesenteric panniculitis. There are several diagnostic and histologic criteria that aid in making the diagnosis of MP. The differential diagnosis for a mesenteric mass includes neoplastic disease, and a biopsy may be indicated to rule out other conditions. While cases of MP with a short duration of symptoms, or spontaneously regression may occur, some patients experience prolonged periods of pain, fever, and alterations in bowel habit, causing significant morbidity. A variety of medical therapies have been suggested for MP. Only two, thalidomide and low-dose naltrexone, have been prospectively evaluated. For patients with chronic MP, good responses to prolonged corticosteroid treatment have been reported. Novel therapies include thalidomide and low-dose naltrexone. Hormonal and immunomodulatory therapies are also used based on small case series, but these treatments may have significant side effects. Surgical intervention is not curative and is avoided except for relief of focal bowel obstruction secondary to fibrotic forms of the disease.
肠系膜脂膜炎（MP）是肠系膜一系列炎症性疾病的首选命名。MP的诊断通常基于肠系膜根部出现的肿块样结构。特征性组织学表现包括局灶性脂肪坏死、慢性炎症，有时还伴有肠系膜纤维化。目前，关于MP诊断和治疗的可靠文献有限。MP被认为是一种免疫介导的慢性炎症性疾病和/或副肿瘤性疾病。其他自身免疫性疾病的个人或家族病史通常较为明显。已经确定了几种可能在疾病发展中起触发作用的诱发事件。创伤、腹部手术、感染和各种癌症都与肠系膜脂膜炎有关。有几种诊断和组织学标准有助于MP的诊断。肠系膜肿块的鉴别诊断包括肿瘤性疾病，可能需要进行活检以排除其他情况。虽然MP患者可能出现症状持续时间短或自发缓解的情况，但一些患者会经历长时间的疼痛、发热和排便习惯改变，导致严重的发病率。对于MP已经提出了多种医学治疗方法。只有沙利度胺和低剂量纳曲酮进行了前瞻性评估。据报道，对于慢性MP患者，长期使用皮质类固醇治疗有良好反应。新的治疗方法包括沙利度胺和低剂量纳曲酮。基于小病例系列也使用激素和免疫调节疗法，但这些治疗可能有显著的副作用。手术干预不能治愈疾病，除了缓解因疾病纤维化形式导致的局灶性肠梗阻外应避免手术。
