Mesenteric lipodystrophy (or mesenteric panniculitis) is a rare condition of unknown etiology that causes inflammation of the adipose tissue in the mesentery. It is important to recognize in order to prevent unnecessary surgery or overly aggressive therapy.


Other synonyms: sclerosing mesenteritis, retractile mesenteritis, lipogranuloma of the mesentery, isolated lipodystrophy, retroperitoneal xanthogranuloma, liposclerotic mesenteritis.


Clinical features include:

(1) slight male predominance, with age often > 50 years

(2) fever of unknown origin

(3) abdominal pain

(4) nausea, malaise and weight loss

(5) abdominal mass

(6) rectal bleeding

(7) jaundice

(8) gastric outlet obstruction or small bowel obstruction

(9) chylous ascites

(10) symptoms may be absent, progressive or intermittent


Criteria for diagnosis (Hemaidan et al, page 514):

(1) presence of a single, multiple or diffuse mass-like inflammatory lesions in the mesentery

(2) histologic confirmation of fat necrosis and inflammatory reaction in the mesenteric lesions, with lipid-laden or foamy macrophages, scattered lymphocytic or plasmacytic infiltrates, lymphoid follicles, foreign body giant cells and fibrosis

(3) exclusion of pancreatitis, inflammatory bowel disease, vasculitis, and Weber-Christian disease (extra-abdominal fat necrosis)


Findings on CT scan of the abdomen:

(1) envelopment of the superior mesenteric vessels by a well-delineated fatty mass with attenuation values higher than those of the retroperitoneal fat, without vascular involvement or invasion into adjacent small bowel

(2) displacement of adjacent bowel loops by a well-delineated fatty mass

(3) well-defined soft-tissue nodules < 5 mm in diameter

(4) fatty halo surrounding vessels and nodules

(5) hyperattenuated stripe

(6) loculated calcifications in the mesentery


The etiology is uncertain. Suggested mechanisms include:

(1) autoimmune disease, rheumatic disease or vasculitis

(2) paraneoplastic process

(3) trauma or previous surgery

(4) drug-induced

(5) infection

(6) thrombosis of mesenteric vessels


Associated diseases found in patients with mesenteric panniculitis include:

(1) none

(2) malignancy or malignant lymphoma

(3) sarcoidosis

(4) cirrhosis

(5) aortic aneurysm

(6) SLE

(6) cholelithiasis


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