Introduction Mesenteric panniculitis (MP) is an inflammatory condition of the bowel mesentery with characteristic features on CT (computer tomography). Studies suggest MP is associated with malignant pathology, previous abdominal surgery, inflammatory and autoimmune diseases. There is a lack of consensus on the clinical significance of MP and its further investigation.
Methods A retrospective analysis of medical records, imaging, endoscopy reports and histology.
Results 58 patients were identified with mesenteric panniculitis by CT criteria during the study period. 8 patients (13.8%) had undergone previous abdominal surgery. 12 patients (20.7%) had a previous history of malignancy; lymphoma 3, prostate 2, bladder 2, both lymphoma/bladder 1, leukaemia 1, endometrial 1, carcinoid 1, and bronchial 1.
Following index CT a new malignancy was identified in 5 patients (8.6%) and recurrence of a previous cancer in 1 (1.7%). 1 patient was diagnosed with lymphoma, 1 gastric carcinoma, 1 malignant myeloma, 1 bronchial carcinoma and 1 bladder cancer. 1 patient was diagnosed with a recurrence of a previously treated lymphoma. Of these 6 patients, 2 underwent endoscopic investigation; gastric carcinoma/lymphoma was suspected on index CT and endoscopy performed for histological confirmation.
Of the remaining 52 patients with MP on index CT (and no new or recurrent malignancy) 18 (34.6%) underwent further endoscopic investigation. None of these patients were diagnosed with a new malignancy at the time of endoscopy; a new diagnosis of ulcerative colitis was made in 2 (3.8%). 15 patients (36.8%) underwent a follow up CT scan within an 18 month period. None were diagnosed with a new malignancy at the time of follow up CT.
Conclusion This study suggests a high prevalence of malignancy amongst patients with MP on index CT. The diagnosis of MP on CT should alert the physician to the possibility of an undiagnosed malignancy.
MP is poorly understood and inconsistently followed up. Its diagnosis can lead to investigation with poor clinical yield and patient/cost implications. This study suggests a diagnostic strategy for underlying malignancy should focus on close evaluation and scrutiny of index CT prior to consideration of further investigation. A larger study is required to identify the prevalence of associated organ specific malignancies, define the diagnostic yield of further investigation and inform an evidence-based diagnostic approach.
Disclosure of Interest None Declared.
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