Mesenteric Panniculitis (Sclerosing Mesenteritis)

Mesenteric panniculitis (MP) is a condition that causes long-term swelling and inflammation in your mesentery. The mesentery is a fold of tissue inside your abdomen that helps to keep organs like your spleen, pancreas and intestines in place. Think of it like a wrap for all the organs in your abdomen.

There are many names associated with MP. This is because providers used to think of them as separate diseases. But new research suggests that they’re different forms of the same condition.

These are the main distinctions between them:

• Mesenteric panniculitis: Inflammation is the main feature.
• Sclerosing mesenteritis (retractile mesenteritis): Thick, stiff scar tissue (fibrosis) forms and is noticeable.
• Mesenteric lipodystrophy: Lots of fat cells begin to die (fat necrosis).

Some researchers prefer to use mesenteric panniculitis as an umbrella term for all of these forms. Others prefer to use sclerosing mesenteritis. This is because these diseases were recently reclassified as the same disease.

Symptoms of mesenteric panniculitis

If you have MP, you probably won’t have symptoms. But if you do, you’ll most likely have belly pain. Other, less common symptoms include:

• Bloating
• Diarrhea or constipation
• Fatigue
• Fever that keeps coming back
• Loss of appetite
• Nausea and vomiting
• Night sweats
• Unintended weight loss

You can also have a soft mass in the middle of your belly. But this symptom is rare.

Mesenteric panniculitis causes

Healthcare providers don’t know exactly what causes MP. But it’s possibly an autoimmune disease. This means that instead of fighting foreign invaders like bacteria and viruses, your immune system attacks healthy tissue by mistake. This can lead to inflammation in your mesentery.

MP sometimes runs in families, so it’s thought that genes play a role. Researchers also think there are certain triggers that may cause this autoimmune reaction. Possible triggers of mesenteric panniculitis include:

• Cancer, like lymphoma, prostate cancer and carcinoid tumors
• Infections, like tuberculosis, typhoid fever and cholera
• Other conditions that involve tissue scarring, like Sjögren’s syndrome, sclerosing pancreatitis and Crohn’s disease
• Surgery on your abdomen

Risk factors

Risk factors might include:

• Coronary artery disease
• History of kidney stones
• Metabolic syndrome
• Obesity

It’s unclear how these conditions relate to MP. But people who have it also tend to have these diseases.

Complications of mesenteric panniculitis

Complications from mesenteric panniculitis are uncommon. But scarring and swelling can block food from passing through your small intestine. Other complications include:

• Ascites: Fluid builds up in your abdomen and expands your belly.
• Kidney failure: Both your kidneys stop working.
• Protein-losing enteropathy: Your body loses too many proteins through your intestines and poop.
• Narrowing of your arteries: This makes it harder for blood to flow where it needs to.
• Sepsis: Your immune system overreacts to an infection, causing widespread, damaging inflammation.
• Venous thromboembolism: A blood clot blocks blood flow through your veins.

How doctors diagnose mesenteric panniculitis

You may not get an MP diagnosis right away. This is because it’s a rare condition, and the symptoms can be confused with other causes. So, your healthcare provider may have to rule those out first.

They might start with a blood test to check for signs of inflammation. If they suspect mesenteric panniculitis, they’ll use imaging tests, like:

• Abdominal ultrasound
• CT scan
• MRI
• PET scan

These allow your provider to look for signs of inflammation, thickening, scarring and tissue death in your mesentery.

They may also look for other signs of MP, like swollen lymph nodes or a ring around blood vessels called the halo sign.

Blood and imaging tests may be enough for a diagnosis. But if your provider needs more information, they may take a tissue sample (biopsy) to send to a lab for testing.

How is mesenteric panniculitis treated?

If you have mild MP symptoms, or none at all, your healthcare provider may simply prefer the “watch and wait” approach. Mesenteric panniculitis typically doesn’t get worse over time and often goes away on its own.

If MP worsens or you have symptoms that disrupt your life, your provider may prescribe:

• Corticosteroids to reduce inflammation, like prednisone
• Immunosuppressants to lower the autoimmune response, like azathioprine
• Hormone therapy to protect against scarring, like tamoxifen

Following an anti-inflammatory diet with your provider’s guidance can help ease symptoms. But it won’t cure MP.

When should I seek care?

Contact your provider if:

• You develop new symptoms.
• Your symptoms get worse.
• Your symptoms don’t improve with treatment.
• You have side effects from your medicine.

Go to the emergency room if you experience:

• Metallic taste in your mouth
• Swelling (especially in your face, hands, arms, ankles or legs)
• Confusion
• Sudden sweatiness or clamminess

What can I expect if I have mesenteric panniculitis?

The general outlook for MP is good. It might not cause any problems for you. It can even go away on its own. MP usually responds well to medications. And if it doesn’t, your provider will work with you to adjust your treatment plan.

Some people with MP can have serious complications, like a bowel obstruction. But this is rare. If it happens, surgery can remove the blockage.