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Mesenteric panniculitis is a rare condition that we're still learning about. It causes chronic inflammation in connective tissue in your abdomen (mesentery tissue). Chronic inflammation eventually causes scarring of the tissues. Treatment with medication usually resolves symptoms.
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Mesenteric panniculitis is a rare disorder affecting the mesentery, a connective tissue structure in the back of your abdominal cavity. The mesentery contains the blood supply to your intestines. It’s part of your peritoneum, the tissue that lines your abdominal cavity and covers the organs inside. The mesentery is made up of folds of peritoneum with adipose tissue (body fat) in between.
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Mesenteric panniculitis affects the adipose (body fat) tissue layer in the mesentery. It causes chronic inflammation, which causes the fat cells to degrade and die (fat necrosis). Over time, it causes fibrosis (scarring) of the tissues. The inflammation in mesenteric panniculitis is idiopathic, which means it appears to happen spontaneously, without any of the usual causes like infection, injury or cancer.
This is a subject of some debate. Most believe that the two conditions are the same. Some have suggested that sclerosing mesenteritis is a more severe or more advanced form of the same disease. And some have suggested that sclerosing mesenteritis might actually be a different disease that follows a different course. While mesenteric panniculitis tends to be stable and treatable, sclerosing mesenteritis might worsen.
The problem is that we still don’t know what causes the inflammation at the root of these conditions. Because of this, we don’t know why it occasionally causes more trouble for some people than others. We can say that most people with idiopathic inflammation in their mesentery have a stable and treatable condition. A few people have a more aggressive condition with more systemic inflammation that can go beyond their mesentery tissue.
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It’s not life-threatening and rarely causes serious complications. Most people have mild to moderate symptoms, and they can go away on their own. But it can cause discomfort, and some people may need medication to treat it. Rarely, it might cause problems by interfering with your intestines. If swelling or scar tissue become too severe, they could obstruct the passage of food through your small intestine.
Mesenteric panniculitis is estimated to occur in about 1.5% of the population. Since it doesn’t always cause symptoms, and the symptoms it does cause are very common, it may be underdiagnosed.
Mesenteric panniculitis is most common after the age of 60. It rarely affects people younger than 20. Some studies suggest it may be twice as common in people assigned male at birth than in people assigned female at birth.
The usual causes of inflammation are infection, injury and malignancy (cancer). This is true in your mesentery tissue as much as anywhere. Inflammation is a response from your immune system. It’s supposed to help tissues heal and help fight off things that might cause infections (pathogens). It’s strange when it occurs without a precipitating condition that needs healing. It’s almost like your immune system is making a mistake.
When your immune system produces a chronic inflammatory response without any disease or injury present, healthcare providers call it an “autoimmune response”. Your immune system is reacting automatically and inappropriately. Healthcare providers theorize that mesenteric panniculitis may be a type of autoimmune disease. These diseases occur in certain people under certain conditions.
Autoimmune diseases tend to run in families. People with mesenteric panniculitis often have a strong family history of autoimmune diseases. These diseases also are often triggered by some temporary condition that is supposed to produce a temporary immune response (like a virus). The immune response continues after the original condition has resolved. Mesenteric panniculitis has often been associated with these types of conditions.
For example:
Mesenteric panniculitis has been reported following abdominal surgery in about 5% of cases.
Previous infections might trigger mesenteric panniculitis. Some research has associated mesenteric panniculitis with a history of chronic infections like:
Mesenteric panniculitis sometimes occurs in people who've been previously treated for cancer. It also sometimes occurs in people with known or soon-to-be-diagnosed cancer outside the mesentery. Previous or current cancer has been reported in up to 30% of cases. Types of cancer associated with mesenteric panniculitis include:
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Mesenteric panniculitis sometimes develops in conjunction with other similar conditions in other places in the body. These conditions are characterized by chronic inflammation that causes progressive scarring (sclerosis or fibrosis). This suggests that whatever causes mesenteric panniculitis may trigger the same response in other places. Other sclerosing conditions that have been reported to occur with mesenteric panniculitis include:
Some people have no noticeable symptoms, while others have many.
The most common symptom is abdominal pain. Inflammation can cause abdominal pain and swollen lymph nodes in the mesentery, which sometimes occur with mesenteric panniculitis.
In some people, abdominal pain is accompanied by:
These symptoms might result from the inflammation encroaching on your intestines.
Some people also have systemic symptoms, which affect your whole body and not just the abdominal area where your mesentery is. These symptoms, including fever and fatigue, are common when your immune system is involved.
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Because it’s so rare and its symptoms are so vague, it often isn’t diagnosed right away. Your healthcare provider may have to rule out many other, more common conditions before they suspect mesentery panniculitis. They may begin with a blood test, which can show signs of inflammation. When they do suspect mesenteric panniculitis, they will use imaging tests (radiology) to look for its characteristic signs.
Mesenteric panniculitis is often recognizable on an MRI or CT scan. The radiologist will see characteristic thickening of the mesentery, signs of fat necrosis (fat cell death and calcification) and fibrosis. The fat tissue may be especially dense in one spot, giving the appearance of a mass. Lymph nodes in the mesentery may be swollen, but the blood vessels aren’t. This is one way of distinguishing mesenteric panniculitis from cancer.
The only definitive way of diagnosing mesenteric panniculitis is to take a tissue biopsy. That means surgically removing a piece of the mesentery tissue and sending it to a lab to analyze. But not everyone will need this kind of definitive diagnosis. Your healthcare provider may already have enough information to prescribe medication to treat mesenteric panniculitis. If the medication works, it also confirms the diagnosis.
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Not everyone needs treatment for mesenteric panniculitis. If you have no symptoms or mild symptoms, your healthcare provider may simply wait and watch it to see if your condition changes. Mesenteric panniculitis usually doesn’t get worse over time, and it often goes away on its own. If you do have symptoms, there are a few standard types of medications that healthcare providers use to treat them.
Corticosteroids, drugs that reduce inflammation, are the first line of treatment for mesentery panniculitis, and they often do the trick. In some cases, your healthcare provider may prescribe additional medications to treat side effects of the condition like nausea. These medications work gradually, so it may be weeks until your symptoms are gone.
If corticosteroids don’t work for you, your healthcare provider may prescribe immunosuppressants. These drugs suppress your overactive immune response. Or they may try low-dose naltrexone (LDN), which also works to modulate your immune system, but by a different approach. Healthcare providers use a trial-and-error process to find the best medication for your symptoms.
In general, mesenteric panniculitis is usually short-lived. It may cause you little to no trouble at all. If you are among the minority who have chronic symptoms from mesenteric panniculitis, your symptoms are likely to respond to medication. Only a few people will have serious complications like a small bowel obstruction. Rarely, these people may need surgery to remove the obstruction.
An anti-inflammatory diet can help to reduce inflammation in your body, particularly in your digestive system. It’s not enough to make mesenteric panniculitis go away, but it could make a difference in your symptoms. An anti-inflammatory diet emphasizes whole foods — foods found in nature — over processed foods found in a package. It also emphasizes healthy, unsaturated fats.
Foods to avoid with mesenteric panniculitis include:
Anti-inflammatory foods include:
The Mediterranean diet is naturally anti-inflammatory. It emphasizes whole foods and healthy sources of omega-3 fatty acids, such as fish, nuts and olive oil.
A note from Cleveland Clinic
Mesenteric panniculitis is a rare condition with much still to be learned about it. Fortunately, it resolves quickly for many people. But if you’re among those whose symptoms are more difficult or persistent, it can be frustrating to have a condition that isn’t well understood. Treatments for mesenteric panniculitis are still experimental. A healthcare provider will work through the options with you, step by step.
Last reviewed on 07/19/2022.
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