|Year : 2021 | Volume
| Issue : 2 | Page : 87-89
A rare case of acute mechanical intestinal obstruction due to isolated mesenteric panniculitis
Ramazan Sari1, Mehmet Zeki Buldanli2
1 Department of General Surgery, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
2 Department of General Surgery, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
|Date of Submission||02-Jun-2021|
|Date of Acceptance||11-Jun-2021|
|Date of Web Publication||23-Jul-2021|
Dr. Mehmet Zeki Buldanli
Medical Doctor, General Surgery Specialist, General Surgery Clinic, 2nd Floor, Gulhane Training and Research Hospital, Postal Code: 06010, Etlik, Ankara
Source of Support: None, Conflict of Interest: None
Mesenteric panniculitis is a rare benign fibrotic condition that manifests with acute or chronic inflammation. It commonly affects small bowels whereas the mesenteric adipose tissue of large bowels is less commonly (20%) involved. In literature, there cases, mostly children and adolescents, where surgery has been used to relieve compression symptoms. We present a rare case of an adult patient who presented with acute mechanical intestinal obstruction secondary to isolated mesenteric panniculitis. We present this case to highlight the fact that this rare condition can cause acute mechanical intestinal obstruction even in adult patients and should be factored into the differential diagnosis.
Keywords: Acute mechanical intestinal obstruction, ileus, mesenteric panniculitis
|How to cite this article:|
Sari R, Buldanli MZ. A rare case of acute mechanical intestinal obstruction due to isolated mesenteric panniculitis. Libyan J Med Sci 2021;5:87-9
|How to cite this URL:|
Sari R, Buldanli MZ. A rare case of acute mechanical intestinal obstruction due to isolated mesenteric panniculitis. Libyan J Med Sci [serial online] 2021 [cited 2023 Mar 27];5:87-9. Available from: https://www.ljmsonline.com/text.asp?2021/5/2/87/322205
| Introduction|| |
Mesenteric panniculitis is a rare benign fibrotic condition that manifests with acute or chronic inflammation. It commonly affects small bowels, whereas the mesenteric adipose tissue of large bowels is less commonly (20%) involved. While it may be secondary to abdominal surgery it may also be due to various factors such as autoimmune disease, malignancy, or infection. Presenting symptoms are generally no specific and vary in relation to the underlying cause. Abdominal ultrasound or computed tomography (CT) can be diagnostic but biopsy is often necessary for absolute diagnosis. Although the management of this condition may vary according to the underlying cause in most cases no specific treatment is needed. In this article, we present a case of isolated mesenteric panniculitis seen in a patient who underwent diagnostic laparotomy for acute mechanical intestinal obstruction. We intend to highlight this rare condition and create awareness among clinicians who may encounter such cases in their daily practice.
| Case Report|| |
A 42-year-old male patient presented to our emergency service with complaints of colic abdominal pain and distention that had persisted for a week. He also complained of nausea and vomiting, constipation for 3 days. Detailed history revealed that the patient had similar complaints that resolved with medical management in the past. He had no history of prior surgery or known comorbidities. On examination, the patient had normal vital signs but distended abdomen accompanied by diffuse tenderness. Bowel sounds were hypoactive. Laboratory tests were unremarkable except for elevated white blood cell count. Abdominal X-ray revealed air-fluid levels [Figure 1]. Intravenous (iv) contrast-enhanced abdominal CT revealed dilated small bowels (4.5 cm) with air-fluid levels, with no simultaneous dilatation of the large bowels. However, the CT revealed no identifiable pathology to explain the apparent intestinal obstruction [Figure 2]. The patient was admitted to the surgical ward. He was maintained on iv fluid while nil per oral. The patient's symptoms did not subside with medical management and were taken to the operating room for exploratory laparotomy the following day. The abdomen was explored via midline incision. The bowels were dilated on edematous. It was noted that a segment of the terminal ileum was compressed by a 4 cm fibrotic tissue that caused complete obstruction of bowels [Figure 3]. The fibrotic band was excised and the bowels free subsequently restoring the bowel flow. No other pathologic findings were noted and the surgery was terminated. Postoperative follow-up was unremarkable. The patient resumed per oral intake by day 2 and was discharged. On the postoperative day 10, the patient was reviewed at surgical outpatient, he had no complaint and his skin sutures were removed. The pathology report of the excised fibrotic band indicated inflammatory tissue with the diagnosis of panniculitis. Informed consent was obtained from the patient to publish this case report.
| Discussion|| |
The term panniculitis entails inflammation of subcutaneous adipose tissue secondary to infection, trauma, malignancy, or autoimmune conditions. Similar inflammation of mesenteric adipose was described in 1924 by Jura as retractile mesentery and alater defined in the 1960s by Ogden as mesenteric panniculitis. A study revealed the history of surgery or trauma in 84% of affected patients. It has been stated that it can be acute or chronic and it is more common in male patients. In our case, an acute clinic was detected in a male patient. As in this case, most cases are idiopathic. There is no accompanying disease and requires no intervention in most cases. Clinically the patients present with nonspecific abdominal pain and symptoms that vary in duration from 24 h to over a year. In our case, the patient had intermittent complaints for almost a year. Because of the rare nature of this condition, there are varied case-by-case management options which include antibiotic therapy, steroids, colchicine, radiotherapy, and surgery. Spontaneous resolution of symptoms is common. In literature; these cases, mostly children and adolescents, where surgery has been used to relieve compression symptoms. The case we present is different in this respect as he was an adult patient. Unlike other intestinal obstruction causes in the case of panniculitis excision of the fibrotic band is sufficient to relieve the symptoms. No further resection of bowels is necessary.
In literature, it has been stated that imaging methods help to achieve the diagnosis. However, histopathological findings are important for definitive diagnosis., In our case, the diagnosis was achieved with the pathology report of the patient who was operated after abdominal X-ray and CT.
Although the clinical entity of the case that we presented was acute mechanical intestinal obstruction, in literature it was stated that mesenteric panniculitis should be kept in mind in cases with unusual presentation of abdominal pain.,
| Conclusion|| |
Isolated mesenteric panniculitis is hard to diagnose but should be noted and should be taken into consideration as a rare cause of acute mechanical intestinal obstruction. We present this case to highlight the fact that this rare condition can be seen even in adult patients.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]