Differential Diagnosis Soft tissue attenuation in the mesenteric fat associated with tethering of the small bowel may represent a neoplastic process such as sarcoma or a carcinoid or desmoid tumor. However, tumors tend to displace vessels rather than surround them. Mesenteric lymphadenopathy, seen in such diseases as mesenteric adenitis, acquired immune deficiency syndrome, Whipple's disease, sprue, sarcoidosis, or tuberculosis, is a less likely consideration. Diagnosis Mesenteric panniculitis Discussion Mesenteric panniculitis is a nonspecific inflammatory and fibrotic process affecting the fatty tissue of the mesentery. The term retractile mesenteritis has been used to describe this process when the predominant component is fibrosis, and mesenteric lipodystrophy has been applied when the primary component is inflammation.
Most cases are idiopathic.
The age range of patients is wide with the peak incidence in the sixth and seventh decades. Symptoms are variable and include abdominal pain, fever, nausea, vomiting, and weight loss. Symptoms often persist for a year or more. Physical examination may be unremarkable or may reveal abdominal tenderness or a palpable mass. Radiologically, upper gastrointestinal and barium enema examinations may demonstrate displacement of bowel loops by a mesenteric mass with the jejunal mesentery most frequently involved.