Review
Mesenteric panniculitis: A comprehensive description of a rare disease
La paniculitis mesentérica: una descripción integral de una enfermedad rara
Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Zhejiang Province, China
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CT: computed tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Mesenteric panniculitis (MP), also named as mesenteric lipodystrophy, mesenteric lipogranuloma, mesenteric sclerosis, and sclerosing mesenteritis, is a rare benign disease with slow-progressing, characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue, mainly involving the mesentery of the small intestine rather than omentum, retroperitoneal, and pelvic fat.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> MP is divided into two categories according to the histological manifestations: the typical MP, which only presents as inflammation and degeneration of mesenteric fat; the retraction MP with fibrosis and contraction of surrounding structures.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> Three development phases of MP are not clearly separated and can co-exist or occur in any order. In the first stage, MP, also called “mesenteric lipodystrophy,” is characterized by foamy macrophages replacing fat cell and which usually asymptomatic. In the second stage, MP is characterized by increased inflammation, lymphatic expansion, and macrophage infiltration, and is often accompanied by mild abdominal discomfort. MP is known as “retractile MP” in the third stage involves collagen deposition and fibrosis, in which there is the annulus fibrosus and soft-tissue mass form, the mesentery is shortened and twisted, and small intestinal obstruction and perforation may be secondary.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">MP is a rare condition usually with asymptomatic. It is difficult to assess how patients respond to current treatment strategies with few studies and cases reported. Although MP is infrequent, it should be considered in patients with abdominal pain that is difficult to diagnose clinically. The purpose of this paper is to describe MP from epidemiology, etiology, histopathology, clinical manifestations, diagnosis, treatment and prognosis, so as it can be deeply understood by the majority of doctors and guide clinical application.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">MP is rarely reported in the scientific literature, and various data are not exact. According to the radiological criteria of several large computed tomography databases, it has been reported that the prevalence of MP is between 0.16% and 7.8%.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> Although the reports are inconsistent, it can be confirmed that MP is a rare disease with a low incidence. The lowest prevalence (0.16%) was reported in a retrospective study based on keyword search results in a CT database.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> A prospective study evaluating 613 patients reported the highest prevalence of MP.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> In most studies, the male to female ratio of patients with MP is 2–3:1 and occurs more often in people aged 50–70 years,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> which may be due to the low basal metabolism and increased abdominal fat. Studies have shown that MP occurs more frequently in older men and patients with higher visceral fat area.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> Otherwise, some cases of children with MP have been reported in journals.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> It appears that there is no clear relationship between the incidence of MP and race.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Etiology</span><p id="par0020" class="elsevierStylePara elsevierViewall">The exact cause of MP is unknown, and it can occur independently or in combination with other diseases. It has been suggested that it is related to a variety of factors such as drugs, mesenteric thrombosis, thermal and chemical damage, bacterial and viral infections. It may be linked to liver cirrhosis, coronary artery disease, metabolic syndrome and tobacco consumption too.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> MP is also associated with malignant diseases, of which the abdominal lymphoma, melanoma, colon and prostate cancer are more common. Emory et al. reported that 84% of patients with MP had a history of trauma or abdominal surgery, and the most common surgical treatments were cholecystectomy, appendectomy, hysterectomy and colectomy, and bariatric surgery. Another study reported that the prevalence rate of MP in patients with a history of abdominal surgery was 9.2%, and that in patients without a history of surgery was 1.1%, with a statistically significant difference.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> In addition, the association between MP and obesity has been increasingly recognized.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Histopathology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Microscopically, the histological changes of mesentery in MP patients are characterized by dispersed lymphoplasmic infiltration, focal fibrosis, fat necrosis, and a mixture of lipid macrophages, which together lead to the thickening and contraction of the mesentery, while the vessels, intestines, and lymph nodes are preserved. The transformation process of macrophages into foam cells in MP may be similar to that of atherosclerosis, accompanied by the up-regulated expression of peroxisome proliferation-activated receptor-γ and scavenger receptors.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> Macroscopically, thickened mesentery can be divided into three types: diffuse mesentery thickening, single nodular thickening at the root of the mesentery, and multiple nodular thickening of the mesentery.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Clinical manifestations</span><p id="par0030" class="elsevierStylePara elsevierViewall">MP is usually asymptomatic, and the scarce clinical presentation is not specific, depending on the size and location of the mass and its relationship with the intestine, blood vessels, and lymph. Only few patients present with excitatory or inhibitory gastrointestinal symptoms, such as abdominal pain, nausea, vomiting, anorexia, early satiety, diarrhea, constipation, etc. Among which abdominal pain is the most common.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Systemic symptoms such as weakness, unexplained fever, weight loss, shivering and chills may occur to few MP patients. In special cases, a tender mass may be touched, and incomplete, progressive, chronic, or even complete intestinal obstruction may occur.</p><p id="par0035" class="elsevierStylePara elsevierViewall">One study found that 16–40% of all patients with MP were asymptomatic, 54–78% MP patients experienced abdominal pain, 9–26% MP patients experienced bloating, 19–25% MP patients experienced diarrhea, 10% MP patients experienced constipation, 18% MP patients experienced vomiting, 13% MP patients experienced anorexia, and 23% with weight loss. Fever occurs in 20% of MP patients, and discomfort and nausea in 5% patients.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Most of MP showed no abnormality on physical examination, and an abdominal mass even tenderness can be touched in 20–30% patients with MP.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> A small number of MP patients will show the signs of concomitant diseases. For instance, tabular abdomen, abdominal tenderness, rebound pain, abdominal muscle rigidity can occur in patients with MP accompanied by peritonitis. If MP patients have ascites in the meanwhile, it can be manifested as increased abdominal circumference and mobile dullness.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Auxiliary examination</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Blood test</span><p id="par0045" class="elsevierStylePara elsevierViewall">Blood tests in patients with MP may be normal, or with slightly elevated inflammatory indicators. One study found that up to 80% of enrolled cases had mild leukocytosis and elevated markers of inflammation, such as erythrocyte sedimentation rate and C-reactive protein, which can be used to monitor response to treatment.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> Anemia and hypoalbuminemia have been reported can occur in patients with MP. It also has been reported that MP patients with systemic lupus erythematosus may present with leukopenia, thrombopenia, hypohemoglobin and as well as positive anti-nuclear antibody, positive anti-SM antibody, positive anti-U1RNP antibody, and lupus anticoagulant tests.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ultrasonography</span><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the influence of abdominal gas, ultrasonography is rarely used for MP. A few articles have reported that ultrasonography can find clear, uniform, high-echo mesenteric masses in patients with MP, which have a clear interface with adjacent normal mesenteric fat with less echo.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Computed tomography</span><p id="par0055" class="elsevierStylePara elsevierViewall">Computed tomography (CT) is the most commonly used diagnostic tool for MP. Most MP is discovered by chance during CT scans for various reasons, and the features of MP in CT are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Typical CT images of MP patient from our hospital are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. If it is inconclusive base on CT scan alone, PET/CT will show high uptake of FDG in mesenteric adipose tissue.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Magnetic resonance imaging (MRI)</span><p id="par0060" class="elsevierStylePara elsevierViewall">The inflammatory of MP is usually low-signaled on T1 and high-signaled on T2, and when fibrosis is dominant, it presents as a local mass of fibrous tissue with both T1 and T2 sequences showing low signaling.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> Typical MRI images of MP patient from our hospital is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pathology</span><p id="par0065" class="elsevierStylePara elsevierViewall">Biopsy is the gold standard of diagnosis and is usually performed during exploratory laparoscopic or laparotomy. Macroscopically, it appears as a necrotic reddish brown or yellowish plaque replacing the normal mesenteric lobular structure, and the peritoneum is also firmly attached to the affected mesentery. It is worth noting that blood vessels are usually unaffected and pass through the mesentery normally.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Microscopically, large amounts of mesenteric fat are infiltrated by macrophages, and significant fibrosis with inflammation and fat necrosis are shown in retractive mesenteritis. In one study, the tissue for biopsy taken from the mesentery and lymph nodes were obtained by laparoscopy, laparotomy or CT-guided needle aspiration.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> It was concluded that the most common histopathological features of MP were fat necrosis (77.7%), fibrosis (68.0%), chronic inflammation (50.5%), calcification (24.3%) and acute inflammation (19.4%). IgG4 immunohistochemical staining was performed in 22 cases (21.4%), of which 12 cases (54.5%) were positive.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagnosis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis of MP is mainly depended on radiology, and most patients are found by chance during abdominal CT scans for other reasons. The MP should be suspected when a mass at the root of the mesentery is discovered, characterized by dislocation of the surrounding structures, whether accompanied by abdominal symptoms or not. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> displays a proposed diagnostic algorithm for MP.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Differential diagnosis</span><p id="par0080" class="elsevierStylePara elsevierViewall">MP needs to be differentiated from a variety of diseases in terms of symptoms, signs and imaging including mesenteric edema, bleeding, lymphedema, inflammation and mesenteric neoplasia. MP also needs to be differentiated from the tumor, especially non-Hodgkin's lymphoma, with 30–50% of non-Hodgkin's lymphoma harboring mesenteric lymph nodes. Peritoneal diseases include omental infarction, peritoneal cancer, and peritoneal mesothelioma are also should be considered. The basic features of rare MP-like peritoneal diseases are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Treatment</span><p id="par0085" class="elsevierStylePara elsevierViewall">MP is a benign self-limiting disease, which means it can spontaneously recover after running a fixed process. Nonetheless, the varying degrees of fibrosis and a variety of clinical symptoms can appear in few patients, who need drug treatment or even surgical treatment. The management principles of MP are shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Medication treatment</span><p id="par0090" class="elsevierStylePara elsevierViewall">Drug is only applicable to symptomatic patients and aims to alleviate symptoms. The immunosuppressants and anti-inflammatory drugs include corticosteroids, colchicine, azathioprine and thalidomide are commonly used in MP patients. And some unconventional drugs including hexonofylline, raloxifene, methotrexate, cyclophosphamide, sulfadiazine, lenalidomide and monoclonal antibodies such as infliximab and rituximab have been reported for chronic MP cases.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Studies have found that prednisone combined with tamoxifen is most effective in relieving symptoms in MP patients receiving medical treatment, and the combination of corticosteroids and tamoxifen has been proposed as the first-line treatment. Azathioprine may be used instead when tamoxifen is unresponsive. It has also been suggested that the efficacy of prednisone plus colchicine is statistically similar to that of prednisone plus tamoxifen, with most patients showing remission even radiological progression after 4–8 months.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> The studies about the drug treatment of MP is infrequent, and the available data and evidence are not sufficient. Based on previous case reports, we tentatively believe that prednisolone alone or in combination is the most effective. It has been recommended that MP can be treated by prednisone 40<span class="elsevierStyleHsp" style=""></span>mg daily, as well as colchicine 0.6<span class="elsevierStyleHsp" style=""></span>mg twice a day and tamoxifen 10<span class="elsevierStyleHsp" style=""></span>mg twice a day. Prednisone was given for a total of 3–4 months, gradually decreasing to 5<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks until it reached 5<span class="elsevierStyleHsp" style=""></span>mg per day, and then discontinued.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">When deciding to start medication, we need to consider the side effects of the medication and weigh the pros and cons. Tamoxifen increases the risk of thromboembolism, while colchicine aggravates the gastrointestinal upset and kidney damage. Furthermore, given the possibility of potential malignancy and the immunosuppression associated with medical management, when mesenteric root mass is difficult to be distinguished from other neoplastic diseases, a biopsy should be performed before starting treatment to rule out malignancy and confirm MP.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Surgical treatment</span><p id="par0105" class="elsevierStylePara elsevierViewall">MP is essentially a self-limiting inflammatory process. However, there are still some patients with progression. Mesenteric collagen deposition and fibrosis, annulus fibrosus and soft-tissue mass formation, mesenteric shortening and distortion, intestinal traction, secondary small intestinal obstruction and perforation can be observed in a few patients with MP. In these circumstances, exploratory surgery is often attempted to relieve symptoms and save lives.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Prognosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">MP is a benign, self-limiting inflammation with a good prognosis. Recurrence and progression to malignancy is rare. There is no clear evidence on whether MP is prone to secondary malignancy. Therefore, we believe that follow-up should be strengthened for MP patients with CT alarm signs, and for common patients without alarm signs, no follow-up can be considered to save resources.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">MP is a rare, slow-progressing benign disease characterized by chronic inflammation and fibrosis of the adipose tissue of the mesentery, mainly involving the mesentery in the small intestine. The etiology and pathogenesis of MP are not clear, but most patients have a history of abdominal surgery and abdominal trauma. Most patients with MP are asymptomatic, only few patients will present with abdominal pain. The diagnosis of MP mainly depends on imaging, among which CT examination is the most commonly used. Specific treatments are not needed in most patients, for patients with obvious symptoms can be treated with medicine, of which glucocorticoids work best. Only minority with intestinal obstruction or perforation need surgery. Most patients with MP do not need follow-up unless whose CT examination suggests right alarm signs.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical considerations</span><p id="par0120" class="elsevierStylePara elsevierViewall">We have followed the protocol of our work center regarding the disclosure of patient data.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors’ contributions</span><p id="par0130" class="elsevierStylePara elsevierViewall">As the authors of the manuscript, YNN drafted the manuscript. DXY critically revised the manuscript. All authors read and approved the final manuscript.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:19 [ 0 => array:3 [ "identificador" => "xres2272648" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1894088" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2272647" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1894089" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Etiology" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Histopathology" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical manifestations" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Auxiliary examination" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Blood test" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Ultrasonography" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Computed tomography" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Magnetic resonance imaging (MRI)" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Pathology" ] ] ] 10 => array:3 [ "identificador" => "sec0060" "titulo" => "Diagnosis" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Differential diagnosis" ] ] ] 11 => array:3 [ "identificador" => "sec0070" "titulo" => "Treatment" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Medication treatment" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Surgical treatment" ] ] ] 12 => array:2 [ "identificador" => "sec0085" "titulo" => "Prognosis" ] 13 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusion" ] 14 => array:2 [ "identificador" => "sec0095" "titulo" => "Ethical considerations" ] 15 => array:2 [ "identificador" => "sec0100" "titulo" => "Funding" ] 16 => array:2 [ "identificador" => "sec0110" "titulo" => "Authors’ contributions" ] 17 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflicts of interest" ] 18 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-04-29" "fechaAceptado" => "2024-08-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1894088" "palabras" => array:4 [ 0 => "Mesenteric panniculitis" 1 => "Etiology and histopathology" 2 => "Diagnosis" 3 => "Treatment and prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1894089" "palabras" => array:4 [ 0 => "Paniculitis mesentérica" 1 => "Etiología e histopatología" 2 => "Diagnóstico" 3 => "Tratamiento y pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mesenteric panniculitis (MP) is a rare disease characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue. It is a benign disease that is influenced by many factors, mainly abdominal trauma and surgery. At present, the pathogenesis and clinical characteristics of MP are still not clear. Most patients with MP are asymptomatic, few will present gastrointestinal symptoms, especially abdominal pain. The diagnosis of MP mainly relies on imaging, such as CT. Medicine treatment is unnecessary for asymptomatic patients, and the curative effect of glucocorticoids is effective in patients with symptom. In the absence of severe intestinal obstruction, surgical treatment should not be considered. The purpose of this paper is to systematically introduce and summarize the epidemiology, etiology, histopathology, clinical manifestations, diagnosis, treatment and prognosis of MP, so as to improve the understanding of this disease.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La paniculitis mesentérica (PM) es una enfermedad rara que se caracteriza por la inflamación crónica y la fibrosis del tejido adiposo mesenterio. Es una enfermedad benigna afectada por múltiples factores, principalmente traumatismos abdominales y cirugía. En la actualidad, la patogénesis y las características clínicas de la PM no están totalmente aclaradas. La mayoría de los pacientes con PM son asintomáticos y rara vez presentan síntomas gastrointestinales, especialmente dolor abdominal. Su diagnóstico se basa principalmente en pruebas de imagen, como tomografías computarizadas. Los pacientes asintomáticos no necesitan tratamiento farmacológico, y los glucocorticoides son efectivos en los pacientes sintomáticos. El tratamiento quirúrgico no debe considerarse sin obstrucción intestinal grave. El objetivo de este trabajo es presentar y resumir sistemáticamente la epidemiología, etiología, histopatología, manifestaciones clínicas, diagnóstico, tratamiento y pronóstico de la PM para aumentar el conocimiento de la enfermedad.</p></span>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 948 "Ancho" => 1005 "Tamanyo" => 102734 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial noncontrast computed tomography image of a 69-year-old woman with mesenteric panniculitis (MP) showing a clear mass-like area of increased fat attenuation within the mesentery with a thin peripheral curvilinear band of soft tissue (arrows), referred to as a pseudocapsule sign. Multiple soft-tissue nodules can be seen inside, with annular adipose low density around them.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 851 "Ancho" => 2150 "Tamanyo" => 195205 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging of a 66-year-old man with mesenteric panniculitis showing a flocculent shadow in the mesenteric region with low signal on T1-weighted sequences and high signal on T2-weighted sequences.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1149 "Ancho" => 1475 "Tamanyo" => 190378 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The diagnostic algorithm for mesenteric panniculitis.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1075 "Ancho" => 1475 "Tamanyo" => 99758 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The management principles of mesenteric panniculitis (MP). CT: computed tomography.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">During the five CT signs (1–5), simultaneous presentation of three or more CT manifestations in a single case may result in the diagnosis of MP; and when any of 6 or 7 of them are present at the same time, the MP is likely to develop into a malignant tumor.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Typical \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CT funding \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mesenteric cellulite lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The mesenteric adipose tissue is denser than the surrounding abdominal tissue \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Soft-tissue nodules surrounding the vascular and perimesenteric \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fatty ring, the normal fat around blood vessels and lymph nodes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Annulus fibrosus (pseudocapsule sign), a thin fibrous margin around the mass, usually less than 3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Large soft-tissue nodules present in cellulite (tubercle diameter greater than 10<span class="elsevierStyleHsp" style=""></span>mm) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal abdominal or pelvic lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3690565.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These two signs are considered as typical radiological markers of MP. It is worth noting that they are not observed in all cases.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Imaging findings in cases of MP.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Omental infarction<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Heterotopic mesenteric ossification<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Peritoneal carcinomatosis<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Encapsulated fat necrosis<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypercoagulability, abdominal surgery or trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exogenous trauma, burn, surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastric and ovarian malignancies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trauma or disruption of vascularization \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal pain, nausea, vomiting, fever, muscle tension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Most are asymptomatic and few present with abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal pain, bloating, abdominal circumference enlargement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal pain, nausea, vomiting, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Image representation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CT: an uneven soft-tissue mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple linear structures with high attenuation can be seen in the mesentery and omentum, and a network lesion can be seen in some cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nodular thickening of the peritoneum and mesentery, along with greater omental nodules and peritoneal strengthening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The encapsulated lesion containing fat and surrounded by soft-tissue stranding \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Course of disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A benign process, inflammatory response subsides leading to complete healing or automatic amputation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benign process with good prognosis, no evidence of potential malignancy at present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malignant course, the survival time of patients is shorter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benign processes, the lesion either resolves or persists with calcified edges \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptomatic analgesic treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-invasive treatments such as NSaids, diphosphonates (desdronate) or radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiotherapy and chemotherapy for malignant tumors; analgesic symptomatic treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analgesic symptomatic treatment, antibiotics \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal obstruction due to adhesions and abscesses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal obstruction or fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peritoneal effusion and multiple organ metastasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary disorders and intestinal obstruction \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3690564.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Differential diagnosis of rare abdominal fatty lesions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT features associated with underlying malignancy in patients with diagnosed mesenteric panniculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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