OVERVIEW
Mesenteric steatitis is a rare mesenteric lesion, clinically manifested as abdominal pain and abdominal mass.Dgder described the pathological process of this disease in 1960, pointing out that the disease is caused by non-specific inflammation of the mesentery extensive thickening, followed by fibrosis, so it is also known as mesenteric lipohypertrophy, mesenteric lipid granuloma, primary mesenteric liposclerosis, isolated mesenteric lipodystrophy, degenerative mesenteritis, Weber-Christian disease, idiopathic constrictive mesenteritis and so on. , degenerative mesenteritis, Weber-Christian disease, and idiopathic constrictive mesenteritis. The majority of the disease has a favorable clinical course and a self-limiting tendency.
Etiology
The etiology of this disease is unknown and may be related to adverse factors such as organic immunocompromise, mesenteric adipose tissue trauma, subacute infections, ischemia, drugs, or allergies. It leads to adipose tissue overgrowth, degeneration, fat necrosis and yellow granulomatous inflammation, release of normal lipids from degenerated adipocytes, granulation tissue infiltration, and formation of fibrosis.
Symptoms
1. General manifestations
The disease is characterized by chronic wasting disease as the main clinical manifestation, which can be seen as low fever, emaciation, fatigue, poor appetite, weight loss, which lasts for several years.
2. Abdominal manifestations
Abdominal pain is mild in the early stage, mainly in the right lower abdomen, the nature of hidden pain, recurrent, tolerable, not metastatic, not radiating elsewhere. Sometimes the mass can be touched, accompanied by abdominal distension, nausea, vomiting. When intestinal obstruction occurs in later stages, the abdominal pain is severe and colicky in nature. When mesenteric vascular strangulation, necrosis of intestinal segments and purulent peritonitis may occur, with persistent abdominal pain and signs of peritoneal irritation.
Examination
1. Laboratory examination
Blood routine: peripheral blood leukocytes can be seen to be elevated. Erythrocyte sedimentation rate increases.
2. Other auxiliary examinations
(1) X-ray examination ① barium meal imaging barium meal imaging of the digestive tract can sometimes be seen in the small intestine displacement or compression, but the intestinal mucosa is normal, barium enema can be seen in the ascending colon or descending colon barium through the obstruction, but the colonic mucosa is not damaged, except for colonic malignant tumors. (2) CT scan: low density, non-homogeneous mass, manifested as fat density area scattered in the water density area or soft tissue density.
(2) Abdominal ultrasound: there is a mass in the right lower abdomen, which is dense and without peritoneum, and sometimes a small amount of peritoneal fluid can be found.
(3) Fiberoptic colonoscopy There is a space-occupying lesion and signs of external pressure on the colon, and there is no ulceration of the colonic mucosa.
Diagnosis
Based on the patient’s history of abdominal surgical disease or abdominal surgery, mesenteric lipomatosis is considered if the patient has the following conditions
1. prolonged course of the disease, prolonged low-grade fever, malaise, emaciation, weight loss, etc.
2. the presence of abdominal pain and abdominal mass, predominantly on the right side of the abdomen or the right lower abdomen, with hard mass, pressure pain, and little mobility.
3. Barium permeation of the digestive tract and fiberoptic colonoscopy show that there is a space-occupying lesion in the digestive tract, and there is no ulcer in the mucosa.
Differential diagnosis
Mesenteric lipomatosis is often misdiagnosed as malignant tumor in the abdominal cavity and should be differentiated from the following diseases:
1. malignant tumors of the colon
Cancer of the ileocecal part and ascending colon can be found as a mass in the right lower abdomen with chronic pain in the right lower abdomen. However, early in the course of colorectal cancer, changes in the nature and habit of stool can be seen, and barium enema and fiberoptic colonoscopy can detect new organisms in the colon.
2. Mesenteric tumor
It is less common, mostly malignant, with rapid progression of disease. Ultrasound-guided fine-needle aspiration biopsy or direct tissue biopsy via laparoscopy can obtain correct diagnosis before caesarean section.
Treatment
The disease has a tendency to be self-limiting and has a good prognosis. After months to years of supportive treatment, the patient’s abdominal pain can be relieved and the abdominal mass can shrink. If the indications are not clear, caesarean section should not be performed.
1. Systemic supportive treatment
Appropriate rest, strengthen nutrition and physical exercise, improve body resistance.
2.Drug therapy
Adrenocorticotropic hormone, antibiotics and triamcinolone can control the symptoms.
3. Radiation therapy
Few patients can get good results.
4.Surgery
The purpose of caesarean section is to clarify the diagnosis (by intraoperative frozen pathology section), remove the lesion, and relieve the compression of the mass on the mesenteric blood vessels and intestinal lumen. Surgical methods can be selected according to the specific conditions of patients.
(1) Adhesion release The main purpose is to release the pressure on the blood vessels and intestinal lumen.
(2) Resection of the lesion If possible, try to remove the mesentery with lesion, but should not hurt the surrounding tissues and organs.
(3) Resection of the intestinal tube If the lesion encroaches into the intestinal wall and causes a stenosis that cannot be corrected, or if the lesion located in the ileocecal region cannot be excluded from malignant tumors, the intestinal tube (small bowel or colon) can be resected and reanastomosed together with the mesenteric lesion.