Mesenteric panniculitis of the colon with obstruction of the inferior mesenteric vein - Report of a case

Mesenteric panniculitis is a rare disease characterized by nonspecific infl ammation of the fat tissue of the mesentery. We present an extremely rare c ase of mesenteric panniculitis of the sigmoid colon, complicated by occlusi on of the inferior mesenteric vein. A 75-year-old male presented with a one -month history of abdominal distention and abdominal mass without pain. Phy sical examination revealed a firm mass in the lower abdomen. Barium enema s tudy demonstrated rugged mucosa and a serrated contour in the rectosigmoid colon. Computed tomography showed that the mass arose from the mesentery, w hich surrounded the mesenteric vessels. The density of the mass was slightl y higher than that of fatty tissue. Based on these radiologic findings, the patient was diagnosed as having mesenteric panniculitis of the rectosigmoi d colon. Colonoscopy showed narrowing with edematous mucosa in the rectosig moid colon, whereas marked dilated vessels were noted in the proximal porti on of the sigmoid colon. Angiography showed occlusion of the inferior mesen teric vein, with venous flow returning c,ia a collateral vein. The patient was observed without medication because his condition was satisfactory. His symptoms subsequently disappeared during a period of several weeks. The ma ss in the lower abdomen gradually diminished in size, disappearing three mo nths later. Computed tomography and barium enema showed improvement of the lesion. The favorable outcome of the present case was probably because of f ormation of a collateral vein. The present case suggests that aggressive th erapy for mesenteric panniculitis should be avoided, because the outcome of this disorder is good, even when there is obstruction of vessels.