The chance case history of an unusual disease: mesenteric panniculitis.

Mesenteric panniculitis was first described by M. Jura in 1927 [1], and is characterized by large mesenteric infiltrations of plasma cells and polymorphonucleate cells. This disease is also known as mesenteric lipogranulomatosis, retroperitoneal xanthogranulomatosis, mesenteric lipodystrophia and mesenteric panniculitis [2–4]. Acute, sub-acute or recurrent abdominal pain occurs in occlusive or subocclusive cases; fever, weight loss and chronic anaemia may be described by patients. Imaging radiology examinations (CT scan, MRI) are now considered very useful in diagnosing the disease, although biopsy also plays a crucial role in diagnostics (Figs. 1, 2). An 84-year-old man suffering from long-term chronic lymphatic leukaemia recently experienced recurrent acute pain in the middle and lower abdomen. Clinical examination revealed no diagnostic signals (abdominal quadrants were easily palpable, both Murphy’s and Mc Burney’s test were negative, there were no clinical signs of acute renal pain). The patient’s abdomen was examined by ultrasound, which showed only biliary microlithiasis. A CT scan of the upper abdomen was clear with non-homogeneous mesenteric adiposity plus many intra-parenchyma inclusions (lymph nodes). The CT scan clearly diagnosed mesenteric panniculitis. The CT images also showed a close relationship between this high adiposity with the part of the bowel that was consistent with the recurrent episodes of pain. The CT scan also showed a large aortic dilatation