Mesenteric lipitis

Introduction to mesenteric lipitis Mesenteric panniculitis (mesenteric panniculitis) is a mesenteric disease characterized by abdominal mass and abdominal pain, which is rare in clinical practice. basic knowledge The proportion of illness: the incidence rate is about 0.025%-0.027% Susceptible people: no specific people Mode of infection: non-infectious Complications: intestinal obstruction

Cause of mesenteric lipitis

(1) Causes of the disease

The cause of this disease is unknown, may be related to abdominal trauma, abdominal surgery, infection, allergies and other factors, because most of the cases reported in the literature have a history of trauma and history of abdominal surgery, it is speculated that trauma and surgery are closely related to the disease, metamorphosis The response may play an important role in the occurrence of this disease.

(two) pathogenesis

Pathogenic defects of the disease include adipose tissue overgrowth and subsequent degeneration, fat necrosis and yellow granulomatous inflammation. After degeneration of proliferative mesenteric adipose tissue, normal lipids may be released from degenerated fat cells. , while promoting granulomatous infiltration, and eventually fibrosis.

The lesion mainly affects the small mesentery, and is more common in the mesenteric root. It can also spread to the intestinal wall. The mesentery can also be affected, but the lesion is often limited. The appearance resembles a colonic malignant tumor. The lesion rarely invades the omentum or Post-peritoneal spread.

The lesions are characterized by scattered necrotic foci on the surface of the affected mesentery. The appearance is dark brown or grayish yellow. The lesions can be fused together to form a large piece, and extend from the mesenteric root to the intestinal wall. The hyperplasia and scar tissue contraction, the mesentery is gradually shortened, the intestinal fistula is also distorted, deformed, narrowed, and even the intestinal lumen is completely obstructed and intestinal obstruction occurs. The mesenteric blood vessels are often surrounded, and the size of the fibrotic lesion is not Etc., but from the laparotomy, most of the diameter is 5 ~ 10cm, the boundary of the mass is unclear, hard, no capsule, and often with the surrounding tissues and organs, complex adhesions, difficult to separate.

Mesenteric lipitis prevention

Avoiding abdominal trauma and various abdominal operations can reduce the incidence of this disease.

Mesenteric lipitis complications Complications, intestinal obstruction

Intestinal obstruction can occur in the late stage of the lesion.

Mesenteric fatty acid symptoms Common symptoms Peritonitis Abdominal tenderness Constipation Loss of appetite Loss of appetite Reduced abdominal distension Thinning panniculitis Peritoneal irritation Low heat

1. The general performance of patients with physical weakness, weight loss, chronic low fever, loss of appetite, and weight loss and other chronic consumption, the course of disease can last for several years.

2. Abdominal performance is mainly abdominal pain, more common in the lower right abdomen, left abdomen and upper abdominal pain can also occur, but less, abdominal pain is not too severe, showing chronic recurrent pain, generally can bear, abdominal pain No metastasis, no radiation to other places, when the intestinal tract is completely occluded with intestinal obstruction, abdominal pain is more severe, sometimes with a sore-like episode, and the mesenteric vessels are strangulated, there may be intestinal necrosis and suppurative peritonitis, this Abdominal pain is persistent and has peritoneal irritation. Under normal circumstances, abdominal tenderness is light, sometimes touching the mass, accompanied by symptoms of bloating, nausea, vomiting and loss of appetite. According to statistics of 68 cases, the incidence of abdominal pain is 67.7. %, vomiting 32.3%, constipation 8.8%, and abdominal mass appearance rate is about 50%.

According to the analysis of 68 cases, about 1/4 of the patients had abdominal surgery, and 22% had undergone abdominal surgery. The following conditions can be considered as mesenteric panniculitis.

Examination of mesenteric lipitis

1. Blood routine peripheral blood leukocytes can be elevated.

2. Erythrocyte sedimentation rate increases.

3. Double contrast angiography of the colon or small intestine shows that the intestinal wall of the lesion is stiff, the tension is reduced, the lumen is narrow, the mucosa is thickened, the disorder is disordered, the edge of the wall is irregularly serrated, and the intestinal tube is externally displaced and deformed. There is a sense of fixation, the tincture passes slowly, the peristalsis disappears or weakens.

4. Colonoscopy showed stenosis of the lumen, poor expansion, mucosal congestion, edema, erosion, easy bleeding, and sometimes ulceration.

5. Abdominal B-ultrasound can detect the mass, the mass is a mixed echo of internal hypoechoic and strong echo of the edge, and the hypoechoic tumor image of the mesenteric root is not uniform. The edge of the mass is unclear and closely related to the intestine.

6. CT scan showed a higher CT value of mesenteric fat, which showed that the fat density of the posterior peritoneum was higher than that of subcutaneous fat, and there was a vascular shadow with increased linear density. Fibrosis could form a soft tissue mass, and calcification could be seen inside. CT sees the internal enhancement of the line-like vascular shadow, which is characterized by a double halo sign inside the thickened intestinal wall. The latter is a characteristic manifestation of benign lesions. The pathological imaging basis is Thickening of the medial low-density submucosal tissue of the intestinal wall, the high density of the outside is the inflammatory cell infiltration and fibrosis of the subserosal tissue.

7. Angiography showed that the superior and inferior mesenteric artery and branch vessels were distorted, compressed, displaced, without tumor staining and arteriovenous fistula, and severe vascular occlusion.

Diagnosis and differentiation of mesenteric lipitis

Diagnostic criteria

According to the analysis of 68 cases, about 1/4 of the patients had abdominal surgery, and 22% had undergone abdominal surgery. The following conditions can be considered as mesenteric panniculitis.

1. The course of the disease develops slowly, from several months to several years, with long-term low fever, chronic consumption of body weight, and weight loss.

2. Abdominal pain and abdominal mass appear one after another, mainly in the right abdomen or right lower abdomen, the abdominal mass is hard, with tenderness, and the activity is extremely poor.

3. Digestive tract perforation and fiber colonoscopy, no ulcers and space-occupying lesions in the digestive tract mucosa.

Differential diagnosis

In gastrointestinal angiography, the disease should be distinguished from gastrointestinal cancer, ischemic enteritis, Crohn's disease, ulcerative colitis, etc. These lesions have corresponding characteristic performance in gastrointestinal angiography, generally not difficult Identification of this disease, it is more difficult to distinguish mesenteric lesions, such as lipoma, liposarcoma, malignant lymphoma, metastasis, peritoneal mesothelioma, pancreatic inflammatory mesenteric changes, abscess, etc., the above tumor lesions in CT The characteristics of each, as long as the attention to the size, number, traits, internal structure and density of the tumor, the presence or absence of adjacent tissue infiltration and infiltration, the presence or absence of metastases and ascites, etc., most can be identified with the disease, if necessary, by blood vessels Contrast, pancreatic inflammatory changes and abscess combined with clinical, laboratory tests and anti-inflammatory treatments are easy to identify.

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