Do you have this strange pain or discomfort in your stomach? Let's talk about Mesenteric Panniculitis!

Do you sometimes feel a vague pain in your stomach, a feeling of fullness, or something strange inside your stomach? Maybe you also feel tired, with a slight fever. Although we often do not pay much attention to such symptoms, sometimes they can be behind them. Today we are going to talk about a less well-known, but worth knowing about, disease. This is what doctors call mesenteric panniculitis . Although the name may seem a bit long, let's understand it simply.

What is Mesenteric Panniculitis? Let's understand it very simply.

Simply put, mesenteric panniculitis is an inflammation of a part of our abdomen called the mesentery . Now you may be wondering what the mesentery is. Imagine, there is a kind of curtain that helps keep our intestines in order and without getting tangled inside the abdomen. This is called the mesentery. This is attached to the back wall of our abdominal cavity and holds part of our small intestine and large intestine. To be precise, this is a connective tissue structure. Inside this mesentery are the blood vessels and lymph vessels that our intestines need. Also, this mesentery is made up of fatty tissue (adipose tissue or body fat) that is located between two folds of the membrane called the peritoneum . In the case of mesenteric panniculitis, there is a long-term inflammation (chronic inflammation) of the fatty tissue layer in the said mesentery. This inflammation damages the fat cells there and causes them to die. This is also called fat necrosis . Over time, scarring (fibrosis) begins to form in these damaged areas. The important thing is that in most cases, there is no clear cause for the inflammation in mesenteric panniculitis. That is, it seems to just happen without any common cause, such as an infection, injury, or cancer. In medicine, conditions that don't have a cause are called idiopathic .

Are mesenteric panniculitis and sclerosing mesenteritis two different things? Are they the same thing?

This is actually a bit of a debate among doctors. Many believe that these two conditions are the same. Some say that sclerosing mesenteritis is a slightly more advanced or severe form of mesenteric panniculitis. Others think that it may be a different disease, with a different course of action. Mesenteric panniculitis is usually stable and treatable. However, there is also the idea that sclerosing mesenteritis can sometimes get worse. The real problem is that we still don't know exactly why the underlying inflammation in both conditions occurs. That's why it's so bothersome for some people and not for others. However, we can say that most people who develop inflammation of the mesentery for no apparent reason have a stable, treatable condition. However, for a very small number of people, this condition can become more severe and the inflammation can extend beyond the mesentery.

Is this situation dangerous? Could it be life-threatening?

Mesenteric panniculitis is usually not a life-threatening condition . It rarely causes serious complications. Most people have mild or moderate symptoms. Sometimes, these symptoms may go away without any treatment.

However, this can cause some discomfort and pain. Therefore, some people have to take medication as a treatment for this. Very rarely, this condition can interfere with the functioning of the intestines . For example, if the swelling or scar tissue caused by inflammation increases too much, it can interfere with the movement of food through our small intestine . This can cause a condition called bowel obstruction . But this happens very rarely.

How common is this condition? Who is more likely to develop it?

This condition is not very common. It is estimated to affect about 1.5% of the population. However, because symptoms are not always present, and the symptoms that do occur (such as abdominal pain) are very common and common to other diseases, it can sometimes go undiagnosed. Mesenteric panniculitis is most common in people over the age of 60. It is rare in people under the age of 20. Some studies suggest that men are twice as likely to develop it as women.

Why does inflammation of the mesentery occur? What are the causes?

Usually, inflammation occurs somewhere in our body due to an infection, injury, or malignancy. This is also common in our mesenteric tissue. Inflammation is a response of our immune system.A response. It's there to help heal tissue and fight off pathogens that cause infection. But it's a little strange that this kind of inflammation occurs without any obvious cause, without a wound that needs to heal. It's like something is wrong with our immune system.

Here are some things that are thought to cause mesenteric panniculitis:

Doctors think that mesenteric panniculitis may be an autoimmune disease . This means that our own immune system, for no apparent reason, attacks our own tissues. This type of autoimmune disease tends to run in families. It can also occur because a temporary condition (such as a viral infection) stimulates the immune system, and the immune response persists even after the condition has resolved. Mesenteric panniculitis has also been linked to these conditions. Here are some examples:

• Surgery : Mesenteric panniculitis is reported to occur in about 5% of patients, especially after abdominal surgery.
• Infections: This condition can also be caused by some previous infections. Research has found that:
• Tuberculosis​
• Typhoid fever
• Cholera
• Syphilis
• This can occur in people with a history of chronic infections such as Whipple's disease.
• Cancer : Sometimes, mesenteric panniculitis occurs in people who have previously been treated for cancer, or who currently have cancer, or who are about to be diagnosed with cancer (cancer outside the mesentery). It has been reported to be associated with a previous or current cancer in about 30% of cases. Examples:
• Lymphoma
• Carcinoid tumors
• Colon cancer
• Kidney cancer
• Prostate cancer
• Other sclerosing conditions: Sometimes, mesenteric panniculitis can occur with other conditions in the body that cause inflammation and scarring (sclerosis or fibrosis). This suggests that the same cause of mesenteric panniculitis can also cause a similar response in other parts of the body. Examples:
• Retroperitoneal fibrosis
• Sjogren's syndrome
• Sclerosing pancreatitis
• Nodular panniculitis
• Crohn's disease

What are the symptoms of Mesenteric Panniculitis?

Some people may not have any symptoms . Others may have a variety of symptoms. The most common symptom is abdominal pain . The inflammation can cause abdominal pain. The lymph nodes in the mesentery can also become swollen. These are common symptoms of mesenteric panniculitis. Some people may also have abdominal pain along with these symptoms:

• Abdominal bloating
• Abdominal swelling
• Feeling full even after eating a little, loss of appetite (Early satiety or loss of appetite)
• Nausea and vomiting
• Constipation or diarrhea
• Weight loss

These symptoms can occur when inflammation affects the intestines. Also, some people may experience systemic symptoms , meaning symptoms that affect the entire body, not just the abdominal area where the mesentery is located. Symptoms like fever and fatigue are common when our immune system is involved.

How do you accurately diagnose this disease? (Diagnosis)

Because it is a very rare disease and the symptoms are so vague (they are similar to many other conditions), it is often difficult to diagnose. Your doctor may need to rule out a number of other, more common conditions before suspecting mesenteric panniculitis. First, they may do a blood test . This can show signs of inflammation. Then, if mesenteric panniculitis is suspected, imaging tests (radiology) are used to look for characteristic signs. Mesenteric panniculitis is often diagnosed with an MRI (Magnetic Resonance Imaging) scan or a CT (Computed Tomography) scan . The radiologist will look for thickening of the mesentery, signs of fat cell death (fat necrosis), and scarring (fibrosis). Sometimes the fatty tissue can become very thick in one area, looking like a tumor. If the lymph nodes in the mesentery are swollen, but the blood vessels are not affected, this is one way to distinguish mesenteric panniculitis from cancer. The only way to definitively diagnose this condition is with a biopsy.This means that a small piece of mesenteric tissue is removed during surgery and sent to a lab for testing. However, not everyone needs this kind of definitive diagnosis. Your doctor may already have enough information to prescribe medication to treat mesenteric panniculitis. If the medication helps relieve your symptoms, that also confirms the diagnosis.

How is treatment done? Does everyone need medication?

In fact, not everyone with mesenteric panniculitis needs treatment. If you have no symptoms or very mild symptoms, your doctor may decide to just wait and watch to see if your condition improves. Mesenteric panniculitis usually doesn't get worse over time, and it often goes away on its own . However, if you do have symptoms, there are several standard medications that doctors use to treat them.

• Corticosteroids: These are medications that reduce inflammation. In most cases, these medications can control symptoms. These are the first-line treatment.
• In some cases, your doctor may prescribe additional medications to help with side effects, such as nausea. These medications work gradually, so it may take several weeks for symptoms to completely go away.

If corticosteroids don't work, your doctor may prescribe immunosuppressants . These medications work by suppressing your overactive immune system. Or, you could try a drug called low-dose naltrexone (LDN) . This also works by modulating the immune system, but in a different way. Doctors use a trial-and-error process to find the one that works best for your symptoms.

What will happen going forward with this situation? (Outlook)

In general, mesenteric panniculitis is usually a short-term condition . You may recover without any problems, or with only minor problems. If you are one of the few people who have long-term symptoms, your symptoms will likely respond well to medication. Only a very small number of people develop serious complications, such as small bowel obstruction . In this case, surgery may be needed to remove the blockage.

Can this be relieved by food and drink? (Dietary control)

Yes, an anti-inflammatory dietFollowing this diet can help reduce inflammation in your body, especially in your digestive system. While it alone won’t cure mesenteric panniculitis, it can make a difference in your symptoms. An anti-inflammatory diet involves eating whole, natural foods instead of packaged, processed foods. It also emphasizes healthy, unsaturated fats.

Reduce or stop eating these foods when you have mesenteric panniculitis:

• Red meat
• Processed meats (like sausages, meatballs)
• Fried foods
• Packaged snacks
• Refined carbohydrates (like white bread made from bread flour)
• High-sugar products (like sweet drinks)
• Saturated fats (like margarine, shortening, animal oils)
• Alcohol

Add more anti-inflammatory foods like these:

• Whole fruits, grains and vegetables
• Leafy green vegetables (like spinach, kale)
• Fish (fish rich in omega-3 like salmon and tuna)
• Plant oils (like olive oil, canola oil)
• Nuts (like almonds, walnuts)
• Turmeric

The Mediterranean diet is a naturally anti-inflammatory diet. It emphasizes whole foods and healthy fats like fish, nuts, and olive oil, which are rich in omega-3 fatty acids . Mesenteric panniculitis is a rare condition that there is still a lot to learn. Fortunately, most people get better quickly. However, if your symptoms are bothersome or persistent, it can be frustrating to have a condition that is not fully understood. Treatments for mesenteric panniculitis are still in the research phase. Your doctor will work with you, step by step, to find a treatment that works for you.

Take-Home Message

Mesenteric panniculitis is an inflammation of the fatty tissue in the mesentery, a part of the abdomen.

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* This is usually not dangerous , and in most cases it can heal on its own .

* Although the exact cause is not known, it is thought to be an autoimmune condition .

* The main symptom is stomach pain . However, bloating, nausea, and fatigue may also occur.

* CT or MRI scans can help with diagnosis. A biopsy may also be needed.

* Not everyone needs treatment. Those with symptoms may find relief with medications such as corticosteroids .

* Following a diet that reduces inflammation can help control symptoms.

* If you continue to have these symptoms, definitely seek medical advice . Don't panic, this is a manageable condition.

Mesenteric Panniculitis, Mesenteric Panniculitis, Stomach inflammation, Abdominal pain, Mesentery, Fatty tissue, Autoimmune diseases, Diet, Treatment, Symptoms, CT scan, MRI scan