Overview
Chronic non-specific inflammatory disease of the mesenteric adipose tissue.
Most of them are asymptomatic, but a few may have symptoms such as vague abdominal pain and abdominal mass.
The exact cause of the disease is not clear, but may be caused by abdominal trauma, surgery, infection, certain diseases, and so on.
Asymptomatic patients do not require treatment, while symptomatic patients are mainly treated with medication, supplemented by surgery if necessary.
Definition
Mesenteric lipomatosis is a rare chronic non-specific inflammatory disease of the mesenteric adipose tissue.
It is also known as: mesenteric lipogranuloma, liposclerotic mesenteritis, and mesenteric lipodystrophy.
More than 90% of patients with lesions in the small bowel mesentery, a small number of patients affect the sigmoid mesentery.
Pathologic features: fibrosis, chronic inflammation and mesenteric fat infiltration.
Most patients are asymptomatic, a few may present with abdominal pain and abdominal mass.
It is not contagious and is mainly treated by medication combined with surgery, with a generally favorable prognosis.
Pathogenesis
Mesenteric lipomatosis is a rare disease, with a prevalence of 0.6% in an overseas abdominal CT study involving 7629 people.
It can occur at any age, and is most common in middle-aged and elderly people aged 50-60 years.
The male:female ratio is 1.5-1.8:1.0.
Causes
Causes
The etiology of mesenteric lipomatosis is unclear. In addition to immunologic factors, it may be related to nonspecific reactions to mesenteric injury caused by abdominal trauma, surgery, infection, and mesenteric vascular disease.
Abdominal trauma, surgery, infection
84% of patients with mesenteric lipomatosis have a history of abdominal trauma or surgery.
Intra-abdominal infections, which can cause inflammation and infection of the mesentery, lead to mesenteric lipomatosis.
Mesenteric vascular disease
Mesenteric vascular diseases such as mesenteric small vessel inflammation, mesenteric thrombosis and mesenteric arteriopathy can cause local ischemia of the mesentery, leading to ischemic necrosis of mesenteric tissues, which in turn leads to mesenteric lipomatosis.
Immune factors
Mesenteric lipomatitis is also associated with hypersensitivity reactions caused by autoimmune diseases.
Malignant tumors
30% of cases of mesenteric lipomatosis are associated with malignant neoplasms (50% of which are lymphomas).
These include chronic granulocytic leukemia and myeloma, pleural mesothelioma, and plasma papillary adenocarcinoma of the uterus.
Other diseases
Mesenteric lipomatosis has also been associated with pancreatitis, bile leakage, cholelithiasis, cirrhosis, abdominal aortic aneurysm, peptic ulcer, and celiac disease.
High risk factors
Advanced age: average age 60 years.
History of abdominal trauma, surgery, and infection.
Suffering from mesenteric vascular diseases such as mesenteric small vessel vasculitis, mesenteric arteriopathy or mesenteric thrombosis.
Suffering from diseases such as pancreatitis, bile leakage, cholelithiasis, cirrhosis, abdominal aortic aneurysm, peptic ulcer.
Symptoms
Most patients are asymptomatic, and the few who are symptomatic typically present with abdominal pain and abdominal mass, which may be accompanied by fever and other symptoms. In severe cases, complications such as small bowel obstruction, mesenteric thrombosis and intestinal lymphatic obstruction may occur, resulting in weight loss, nausea, vomiting, abdominal distension, diarrhea, cessation of defecation, fatigue, and emaciation.
Main Symptoms
Abdominal pain
Mesenteric lipomatosis can cause chronic inflammation, leading to abdominal pain.
Abdominal pain is mainly vague pain, or recurrent spasmodic pain, the course of the disease can be delayed for several years.
Abdominal pain is mostly located in the right side of the waist, but can also be diffuse.
Abdominal mass
Mesenteric lipomatosis can cause collagen deposition, mesenteric fibrosis, resulting in mesenteric scarring and retraction, followed by the formation of abdominal mass.
60% may have an abdominal mass that is firm, poorly mobile, and tender, but usually without signs of peritoneal irritation.
Fever
Fever is usually low grade and is seen in 60% of cases.
Symptoms of small bowel obstruction
If mesenteric lipomatosis is left untreated, collagen deposition can cause mesenteric scarring and retraction, followed by intestinal obstruction.
Symptoms such as abdominal pain, vomiting, abdominal distension, and cessation of anal evacuation may be present.
Symptoms of mesenteric thrombosis
Thickening of the mesentery, encircling the mesenteric blood vessels, causing vascular obstruction and formation of mesenteric thrombosis.
There may be anorexia, abdominal pain, vomiting, change of bowel habit (including diarrhea, constipation, blood in stool), weight loss and emaciation.
Symptoms of intestinal lymphatic obstruction
Thickening of the mesentery, encircling the mesenteric blood vessels, causing lymphatic obstruction.
In severe cases, the obstruction of intestinal lymphatic vessels affects the return of lymphatic fluid and blood, resulting in accumulation of fluid in the abdominal cavity, which is manifested as abdominal distension, abdominal distension, anorexia, malaise, nausea, diarrhea, emaciation, and abdominal pain.
Complications
Intestinal perforation
If mesenteric lipomatosis progresses to the stage of regressive mesenteritis, symptoms of intestinal obstruction occur, leading to increased pressure in the intestinal lumen, which may cause intestinal perforation.
Symptoms such as severe abdominal pain, abdominal distension, fever, malaise, chills, etc., as well as the triad of peritoneal irritation (abdominal pressure, rebound pain, abdominal muscle tension) may be present, and even shock may occur.
Carcinoma
The majority of mesenteric lipomatosis is benign, about 30% may become malignant, of which 15% of mesenteric lipomatosis is malignant lymphoma.
Consultation
Department of Medicine
General Surgery
If you have abdominal pain, abdominal mass, anorexia, nausea, abdominal distension, fever, or stop defecation, we recommend you to consult a doctor promptly.
Gastroenterology
You can also consult the Department of Gastroenterology for the above symptoms.
Preparation
How to get to the doctor: registering, preparing documents, and common problems.
Tips for the doctor
Take rest and avoid strenuous exercise before going to the doctor.
Preparation Checklist
Symptom list
Pay special attention to the time of onset of symptoms, special manifestations, etc.
Is there any abdominal pain, and what are the location, degree, triggering and relieving factors of the pain?
Is there an abdominal mass and when did it appear?
Are there any symptoms such as anorexia, nausea, bloating, fever, etc.?
Has there been any recent defecation or bowel movement, and are there any abnormalities in the feces?
List of medical history
Any history of abdominal trauma, surgery, infection?
Any mesenteric vascular disease, autoimmune disease?
Any pancreatitis, bile leakage, cholelithiasis, cirrhosis, abdominal aortic aneurysm, peptic ulcer, celiac disease?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Laboratory tests: routine blood test, C-reactive protein, blood sedimentation, blood biochemistry, pathogen detection and drug sensitivity test
Imaging tests: abdominal ultrasound, X-ray barium meal imaging, abdominal CT, magnetic resonance imaging (MRI), mesenteric angiography.
Pathologic examination: pathologic histologic examination.
List of medications used
Medication used in the last 3 months, if available in boxes or packages, bring them to the doctor’s office
Immunosuppressive drugs: cyclophosphamide, azathioprine, etc.
Glucocorticoids: prednisone, etc.
Diagnosis
Diagnostic basis
Mesenteric lipomatosis can be initially diagnosed on the basis of history, clinical manifestations, laboratory and imaging studies. Definitive diagnosis requires histologic examination.
Medical history
History of abdominal trauma, surgery, and infection.
History of mesenteric vascular disease, autoimmune disease.
History of cholelithiasis, cirrhosis, peptic ulcer.
Clinical manifestations
May have abdominal pain, abdominal mass.
Fever, abdominal pain, nausea, vomiting, anorexia, fatigue, emaciation, change in bowel habit (including diarrhea, constipation, blood in stool).
Laboratory tests
Laboratory tests are normal in most patients.
Blood counts, C-reactive protein, and sedimentation rate.
Some patients may have elevated white blood cells, C-reactive protein (CRP), and increased sedimentation rate.
Mean corpuscular volume (MCV) <80fl, mean corpuscular hemoglobin (MCH) <27Pg, mean corpuscular hemoglobin concentration (MCHC) <32% may indicate iron deficiency anemia.
Blood biochemistry
The presence of albumin <30 g/L suggests the presence of hypoalbuminemia.
Pathogen detection and drug sensitivity testing
Pathogen culture of the blood can clarify the presence or absence of pathogen infection and the specific type of pathogen infecting the blood.
Drug sensitivity tests measure the sensitivity of microorganisms to various antimicrobial drugs. Appropriate drugs can be selected for treatment based on the drug sensitivity test.
Imaging
Abdominal ultrasound, barium meal X-ray imaging
It helps to find the abdominal mass and the relationship between the mass and the intestinal tube and abnormal signs such as intestinal stenosis and intestinal obstruction, and can assist in the diagnosis of mesenteric lipofuscinosis, but the value is limited.
Fasting is required before the examination to prevent the results from being affected.
If symptoms of intestinal obstruction are present, X-ray barium meal contrast is not feasible.
Abdominal CT
It is the preferred method for diagnosing mesenteric lipomatitis, which can clarify the scope of the lesion and help to identify it.
Do not have metal objects on your clothing during the examination. It is contraindicated in women during pregnancy.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging shows fat, soft tissue and blood vessels better than CT and can clarify the extent of mesenteric lipomatosis lesions, especially fibrous tissue and blood vessels, which is helpful in making a definitive diagnosis of mesenteric lipomatosis.
All metal objects should be removed from the body before the examination.
If the patient has a metal pacemaker, stent, or steel plate in the body, the MRI should not be performed. If an MRI is necessary, the staff must be told what kind of metal is in the body to assess whether the test can be performed.
Mesenteric Angiography
Mesenteric angiography can assist in the diagnosis of mesenteric lipomatosis and clarify the blood supply of the mass.
The presence of a mass with multiple or few blood supplies, or irregular distortion, aggregation, or occlusion of the distal end of the intramural branches of the ileocaecal artery, is suggestive of mesenteric lipofuscinosis.
Angiography is not feasible in patients who are allergic to contrast media or anesthetics.
Pathologic examination
Histologic examination
Ultrasound or CT-guided percutaneous puncture of the abdominal mass can be used to confirm the diagnosis by histopathologic examination.
For those who are difficult to diagnose mesenteric lipomatosis, it is feasible to perform a caesarean section and take specimens for histopathologic examination to confirm the diagnosis.
If one or more of the three pathological changes of fibrosis, chronic inflammation or mesenteric fat infiltration is found in the histopathological examination, the diagnosis of mesenteric lipomatosis can be confirmed.
Differential diagnosis
Mesenteric lipomatosis should be differentiated from carcinoid tumors, metastatic carcinomas, lymphomas, smooth muscle tumors, fibrous tumors, and lipoid tumors.
Carcinoid tumor
Similarities: both can occur in the intestines, both have symptoms such as abdominal pain, diarrhea, nausea, vomiting, and abdominal mass.
Differences
Carcinoid tumors are malignant tumors that mainly occur in the gastrointestinal tract, but can involve most organs of the body.
Carcinoid syndrome (skin flushing, diarrhea, abdominal pain, asthma) is often manifested.
Imaging and pathologic tests are helpful for differentiation.
Metastatic carcinoma
Similarity: both have symptoms such as abdominal pain, diarrhea and abdominal mass.
Differences: metastatic carcinoma is a malignant tumor, and a history of primary tumor and the absence of fat density foci in the mass on imaging can help to differentiate it.
Lymphoma involving mesentery
Similarity: both have symptoms such as abdominal mass.
Differences: Lymphoma mostly involves the retroperitoneal space, and the typical clinical symptoms are painless lymph node enlargement, often with hepatosplenomegaly, and malignancy, fever and anemia in advanced stage. Imaging and pathologic examination are helpful for differentiation.
Smooth muscle tumor
Similarity: both have symptoms such as abdominal pain and abdominal mass.
Differences: Most of them originate from the gastrointestinal wall and cannot be separated from the internal organs. Sudden contraction of smooth muscle in response to cold or emotional excitement may cause severe pain. Imaging and pathologic examination can help to differentiate.
Fibroma
Similarity: both have symptoms such as hard abdominal mass.
Differences: Fibroma is easy to occur in surgery, trauma, slow-growing, usually no abdominal pain and other symptoms. Pathologic and histologic findings can help to differentiate them.
Fatty tumors
Similarity: both have symptoms such as abdominal mass.
Difference: Fatty tumors include lipoma, liposarcoma, medullary tumor, angiomyolipoma and teratoma, which usually do not have symptoms such as abdominal pain, and it is not easy to differentiate them from CT, and can be identified by histopathological examination.
Treatment
Most of the disease can be cured spontaneously, and no treatment is needed for those who do not have symptoms.
The purpose of treatment is to relieve symptoms, prevent and minimize recurrence.
Treatment principle: medication is the main treatment for symptomatic patients, and surgery is necessary.
Medication
If fever, nausea, vomiting and diarrhea occur, or if the disease spreads to the whole body, anti-infective and immunosuppressant treatments can be applied.
Anti-infection
When mesenteric lipomatitis is caused by infection, antibiotics can be used empirically first, and after the causative organisms are clearly identified, drugs can be selected according to the drug sensitivity test.
Commonly used drugs: penicillin, cephalosporin.
Precautions: Before use, the doctor should be informed of any history of drug allergy.
Application of immunosuppressant
Treatment of mesenteric lipomatitis by controlling the pathogenic effect of inflammatory immune factors.
Commonly used drugs: glucocorticoids (prednisone), cyclophosphamide, azathioprine.
Precautions for use
It is contraindicated for those who are allergic to the product, pregnant and lactating women, those with hepatic or renal insufficiency, and those with severe bone marrow suppression.
Cyclophosphamide metabolites have an irritating effect on the urinary tract, and more water should be drunk.
Prednisone is a glucocorticoid, and is generally contraindicated in hypertension, diabetes mellitus and gastric and duodenal ulcers, as well as in surgical patients, to avoid affecting wound healing.
Adverse reactions
Cyclophosphamide: Bone marrow suppression (leukopenia, thrombocytopenia), hepatic impairment, gastrointestinal reactions (e.g., loss of appetite, nausea and vomiting), urinary tract reactions (bladder irritation, oliguria, hematuria, and proteinuria), and other reactions including alopecia, stomatitis, toxic hepatitis, and menstrual disorders.
Azathioprine: may cause bone marrow suppression (leukopenia, thrombocytopenia, and megaloblastic anemia), gastrointestinal symptoms (nausea, vomiting), gastrointestinal and oral ulcers, hepatic impairment, and alopecia. There may be an increased incidence of infections and tumors. Occasional male sperm reduction and teratogenic effects.
Prednisone: Higher doses are prone to hyperglycemia, gastrointestinal ulcers and pharmacologic Cushing’s syndrome (weight gain, full moon face, buffalo back, centripetal obesity, etc.), which is often complicated by infections.
Treatment of primary diseases and complications
Actively treat primary diseases and complications, such as mesenteric vascular disease, autoimmune disease, intestinal obstruction, etc.
Surgery
Generally, mesenteric lipomatosis does not require surgical treatment, but only when there are complications such as intestinal obstruction, intestinal perforation, or severe symptoms.
Indications for surgery
Ineffective drug treatment, serious complications such as intestinal obstruction, intestinal perforation, etc.
Suspected other surgical diseases: obvious abdominal pain, abdominal mass, or large abdominal mass compressing the intestinal lumen, resulting in a high degree of narrowing of the intestinal lumen.
Those who have difficulty in identifying with colon cancer, lymphoma, etc., and it is difficult to confirm the diagnosis without surgery.
Surgical approach
Specific surgical methods should be decided according to the degree of mesenteric inflammation and fibrosis and the involvement of intestinal tubes.
Intestinal adhesion release surgery
Objective: to separate intestinal adhesions and relieve intestinal obstruction.
Indications: Adhesive intestinal obstruction is ineffective by non-surgical treatment, or recurrent after relieved by non-surgical treatment.
Contraindication: those with severe abdominal distension, intestinal perforation, peritonitis.
Intestinal resection and anastomosis
Purpose: resection of lesions, prevention of diffusion and metastasis, relief of adhesion and obstruction, removal of necrotic tissue.
Indications: those suffering from intestinal tumor, intestinal necrosis, intestinal perforation, intestinal inflammatory lesions, adhesive intestinal obstruction.
Contraindications: those with severe coagulation disorders, poor physical condition, and those who cannot tolerate the surgery.
Enterostomy
Purpose: to relieve intestinal obstruction.
Indications: patients with severe intestinal obstruction not relieved by medical treatment.
Contraindication: those with ascites.
Precautions
Appropriate postoperative activities should be carried out in the early stage to promote intestinal peristalsis and prevent new intestinal adhesions from occurring.
After the operation, when the intestinal function recovers (such as defecation), fluid food can be eaten.
Enterostomy pay attention to the stoma care, timely clean up feces and gas.
Prognosis
Cure
Mesenteric lipomatosis is a benign disease, most of which can be cured by itself without special treatment and has a good prognosis.
If there are symptoms or the lesion extends to the whole body, after active treatment, the general prognosis is good. Some patients with untimely treatment are prone to recurrent episodes and have a poor prognosis, which affects their health and quality of life.
Harmfulness
If there are symptoms and untimely treatment, complications such as small bowel obstruction, mesenteric thrombosis, intestinal lymphatic vessel obstruction and intestinal perforation may occur.
The disease has the possibility of cancer, and 15% of patients are malignant lymphoma.
Daily
Daily Management
Dietary management
To wait for gas drainage before starting to eat, small and frequent meals, transition from liquid food to general food.
Reasonable arrangement of diet, balanced nutrition and enhancement of immunity.
Eat light, soft and easy-to-digest food, such as millet porridge.
Avoid spicy and stimulating foods that are easy to bloat.
Life management
Combination of work and rest, appropriate exercise during the recovery period of the disease to enhance immunity in order to promote recovery.
Pay attention to rest, do not stay up late, avoid exertion as well as strenuous exercise.
Maintain personal hygiene and good living habits.
Psychological support
Due to the long duration of the disease and easy to recur, this disease is prone to anxiety and fear.
It is recommended to take the initiative to learn about mesenteric lipomatosis from healthcare personnel to reduce anxiety.
Family members should accompany and enlighten the patient to help the patient build up confidence in cure and relieve the patient’s anxiety.
Disease monitoring
Patients with mesenteric lipomatosis need to be closely monitored for changes in their condition, especially whether symptoms such as abdominal pain and abdominal mass have improved.
Follow-up
Regular follow-ups should be conducted during the recovery period so that the doctor can assess the changes in the patient’s condition, prevent recurrence and combat complications.
Follow-up time: Regular follow-ups should be conducted according to the doctor’s instructions formulated by the specialist in accordance with the patient’s specific condition.
Tests to be done during follow-up: abdominal ultrasound, barium meal X-ray, abdominal CT, magnetic resonance imaging (MRI), mesenteric angiography, etc.
Prevention
Promptly control the infection of abdominal surgery or abdominal trauma and strengthen immunity.
Timely and standardized treatment of cholelithiasis, liver cirrhosis, mesenteric thrombosis, mesenteric infection, peptic ulcer, malignant tumors and other diseases that may cause mesenteric lipomatosis.
Middle-aged and elderly people should pay attention to observe whether there are abdominal masses and other discomforts, and consult a doctor promptly if there are discomforts.
Regular medical checkups, abdominal ultrasound, CT and other tests can be used to screen for mesenteric lipomatitis.