Introduction Mesenteric Panniculitis (MP) is a chronic inflammatory process of the small bowel mesentery, increasing in prevalence with advances in computer tomography (CT) imaging. An association between MP and development of malignancy has been suggested, however evidence is low quality and inconsistent, with no previously published UK cohorts. This leaves the patient and clinician with complex decisions regarding risks and benefits of follow-up imaging.
Method We performed a literature search and developed a local guideline on diagnosis and surveillance of MP. We retrospectively audited all patients with a CT report containing MP over a 12 month period. Patient electronic records were reviewed for details of diagnostic criteria, incidence of active malignancy and surveillance strategy. We assessed radiological diagnosis against Coulier’s criteria: ³3 CT features of a mass effect on neighbouring structures, high attenuation mesenteric fat, small soft tissue nodes, a surrounding low attenuation fatty halo, or a hyperattenuating pseudo-capsule surrounding the entity.
Results We identified 82 patients, 62% male, median age 67 years (range 31–92 years). 71 reports (87%) did not describe the recommended minimum 3 features of MP. 23 patients (28%) had an active malignancy on CT imaging, 7 patients (9%) were being followed up for previous malignancy. Lymphoma and colorectal cancer were the most common primary malignancies seen.
Of the 59 patients without an active malignancy, 10 patients (17%) went on to have further CT imaging. The median interval between first and second CT was 6 months, range 2–18 months, no subsequent imaging of these patients demonstrated a malignancy. None of these 59 patients went on to develop a malignancy, diagnosed in our region, with a minimum of 18 months’ follow-up.
Conclusion With improved imaging of small bowel mesentery, radiologists should consider reporting Coulier’s criteria present when diagnosing MP. In this UK cohort we demonstrated a similar prevalence of malignancy at diagnosis of MP to previously published data, emphasising the importance to assess for risk of malignancy at presentation. Like previous cohorts, none of our 59 patients without malignancy at diagnosis went on to develop a malignancy, suggesting CT surveillance in asymptomatic patients is likely to be of low yield.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.