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Widespread free fluid in abdomen CT. (Case 1)
Source publication
Açarı C, Ünsal E, Hakgüder G, Soylu A, Özer E. Pediatric mesenteric panniculitis: three cases and a review of the literature. Turk J Pediatr 2019; 61: 798-803. Mesenteric panniculitis is an inflammatory and fibrotic process in the mesenteric adipose tissue with unknown etiology. It is rarely seen in general, particularly in children. Etiology is un...
Contexts in source publication
Context 1
... computed tomography (CT) showed widespread free fluid. (Fig. 1) Radiologic findings were not specific for any diagnosis. Intestinal obstruction was suspected. Explorative laparotomy was applied for the differential diagnosis. Dense lipid deposits were observed on the appendix and the mesentery of small intestine. Histopathological sections of the biopsy materials showed focal necrosis, suppurative ...
Context 2
... computed tomography (CT) showed widespread free fluid. (Fig. 1) Radiologic findings were not specific for any diagnosis. Intestinal obstruction was suspected. Explorative laparotomy was applied for the differential diagnosis. Dense lipid deposits were observed on the appendix and the mesentery of small intestine. Histopathological sections of the biopsy materials showed focal necrosis, suppurative ...
Context 3
... computed tomography (CT) showed widespread free fluid. (Fig. 1) Radiologic findings were not specific for any diagnosis. Intestinal obstruction was suspected. Explorative laparotomy was applied for the differential diagnosis. Dense lipid deposits were observed on the appendix and the mesentery of small intestine. Histopathological sections of the biopsy materials showed focal necrosis, suppurative ...
Citations
... Sometimes patients may present fever of unknown origin, nausea, vomiting, weight loss, and constipation. Rare presentations include rectal bleeding, jaundice, gastric outlet obstruction, and acute abdomen [53][54][55]. ...
... Color Doppler mode may show non-deviated mesenteric vessels within the mass with a linear trajectory and branching spatial arrangement (Fig. 7). The differential diagnosis from OI is very difficult, but an US diagnostic clue is its common location in the root of the small-bowel mesentery that does not abut the colonic wall, with the appearance of a large aspecific inflammatory infiltrate, vascularized on color Doppler mode and with a cluster of nodes inside [53][54][55]. ...
Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.
La paniculitis mesentérica (PM) es una enfermedad inflamatoria que afecta el mesenterio intestinal, con mayor predisposición en el sexo masculino. No se conoce la causa específica, pero en la mayoría de los casos se relaciona con la necrosis tisular producidos por infecciones, traumatismos o procesos autoinmunes; lo que nos determina una clínica inespecífica caracterizada comúnmente por dolor abdominal, distensión abdominal y diarrea. Realizar una investigación y estudio de casos acerca de la paniculitis mesentérica con la finalidad de determinar sus posibles etiologías, síntomas y métodos diagnósticos de la enfermedad. Se trata de un estudio documentado y de casos investigados en un periodo de 2016 al 2021 en varios servidores web como Pubmed, descriptores de Salud como DeCS, ClinicalKey y MeSH. La clasificación más habitual presentada fue la te tipo I con un 43%. La media edad fue 61, 7 años aumentando su prevalencia con la edad, y afectando principalmente al sexo masculina con una relación 2:1. La clínica mediante descripción de cuadros de dolor abdominal crónico (72%), distensión abdominal (26%) y diarrea (25%), siendo hallazgos infrecuentes las náuseas, vómitos, estreñimiento, fiebre, adelgazamiento y ascitis, pero un gran porcentaje son asintomáticos. Dentro del diagnóstico el método de elección es la tomografía computarizada y en el tratamiento no hay parámetros definidos, pero se ha reportado el uso de corticoesteroides e inmunosupresoras, en algunos casos se menciona la cirugía, pero esta no es recomendable.
Objectives:
To analyze the computed tomography (CT) findings of idiopathic mesenteric panniculitis and the factors related to its characteristics and to improve the understanding of the disease.
Methods:
The imaging findings of 121 patients with mesenteric panniculitis were retrospectively analyzed, along with related factors such as age, sex, and abdominal visceral fat area.
Results:
Among the 121 patients, two had midgut malrotation, and the lesions were located outside the mesentery on the right side of the abdominal cavity, while the lesions in the other patients were located around the mesentery on the left side of the abdominal cavity, presenting as patchy or patchy fuzzy high-density masses. Annulus fibrosus and/or fatty ring signs were also observed in some patients. Scattered soft tissue nodules were observed around the mesentery in 119 patients. Eight patients had intestinal tract traction and retraction, and one patient had secondary intestinal obstruction. Nearly half of the patients had mesenteric vascular changes, and three had mesenteric vascular thrombosis. Among the 121 patients, there were 89 males and 32 females, aged 22-83, with an average age of 52.14 ± 13.53 years. The distribution range of abdominal visceral fat area (VFA) in 121 patients was 79.85-331.65 cm2.
Conclusion:
Mesenteric panniculitis has certain characteristic imaging findings that can be accompanied by often ignored changes in the mesenteric blood vessels and intestinal tubes. Intestinal obstruction and mesenteric vascular thrombosis are rare complications, and their primary causes are often overlooked. Mesenteric panniculitis was correlated with sex, age, and VFA.
