Mezenterik Pannikülit

Yıl 2013, Cilt: 4 Sayı: 4, 173 - 176, 01.10.2013

Nurşah Başol Ufuk Taş Murat Ayan Mehmet Esen Muhammet Arslan İlyas Koç Berat Acu

Öz

Peritonun çift katlı tabakası olan mezenterium ince bağırsakları
(jejunum ve ileum) karın arka duvarına asar. Mezenterin her iki
yüzünde peritonun çift katmanı arasında a.mesenterica superior
ve dalları, bunlara eşlik eden venler, lenfatikler, lenf düğümleri,
otonom sinir pleksusları, bağ dokusu ve kök civarında daha büyük
miktarda bulunan değişik miktarlarda yağ dokusu vardır. Mezenterik
pannikülit; yağ nekrozu, kronik inflamasyon ve fibrozis ile karakterize
iyi huylu bir hastalıktır. Etiyolojisi net olmamakla birlikte
geçirilmiş abdominal cerrahi, malignensiler gibi ilişkilendirildiği
pek çok hastalık mevcuttur. Mezenterik pannikülit, semptomsuz
seyredebileceği gibi karın ağrısı, abdominal distansiyon, ele gelen
kitle, ateş gibi semptomlarla da seyredebilir. Tanısında Laboratuvar
tetkikleri non spesifiktir. Tanısı genelde USG ve batın BT
ile konulsa da kesin tanıya histopatolojik incelemeler neticesinde
ulaşılır. Mezenterik pannikülit de genellikle semptomatik tedaviler
uygulanmakla birlikte immünsüpresif ajanlar yada steroidlerin
etkili olduğu da bildirilmiştir. Bu çalışmada biz acil servise karın
ağrısı şikayeti ile başvuran ve mezenterik pannikülit tanısı konulan
üç olguyu sunduk, böylelikle karın ağrısının bu nadir sebebine
dikkat çekmek istedik.

Anahtar Kelimeler

Mezenter, pannikülit, karın ağrısı

Panniculitis of the Mesentery

Öz

The mesentery is the double layer of peritoneum that suspends the small intestine (jejunum and ileum) from the posterior wall of the abdomen. The superior mesenteric artery and its branches, accompanying veins, lymphatic, lymph nodes, the autonomic nerve plexuses, with a larger amount of connective tissue and varying amounts of fat tissue around the root of the mesentery, are located between two layers of peritoneum. Mesenteric panniculitis is a benign disorder that characterised by fat necrosis, chronic inflammation, and fibrosis. Although the aetiology is not clear, it is associated with many diseases, such as previous abdominal surgery, and malignancies. Mesenteric panniculitis may be asymptomatic or accompanied by symptoms such as abdominal pain, abdominal distention, palpable mass, and fever. Laboratory tests are non-specific in diagnosis. Although diagnosis of the disease is usually with ultrasound and abdominal CT is definitive, diagnosis is made by histopathological examination. Usually, symptomatic treatments are administered in mesenteric panniculitis; however, immunosuppressive agents or steroids have also been reported to be effective. In this study, we report three cases admitted to the emergency room with abdominal pain and diagnosed as mesenteric panniculitis, to draw attention to the cause of this rare abdominal pain

Anahtar Kelimeler

Mesentery, panniculitis, abdominal pain

Kaynakça

• Esses D, Birnbaum A, Bijur P, Shah S, Gleyzer A, Gallagher EJ. Ability of CT to alter decision making in elderly patients with acute abdominal pain. Am J Emerg Med 2004; 22: 270-2. [CrossRef]
• Graff LG, Robinson D. Abdominal pain and emergency department evaluation. Emerg Med Clin North Am 2001; 19: 123-36. [CrossRef]
• Lameris W, Randen A, Dijkdraaf M, Bossuyt P, Stoker J, Boermeester M. Opti- mization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and raionale. BMC Emerg Med 2007; 7: 9. [CrossRef]
• Emet M, Eroğlu M, Aslan Ş, Öztürk G. Approach to Patient with Abdomi- nal Pain. EAJM 2007; 39: 136-41.
• Pokharitov A, Chomov G. Mesenteric panniculitis of the sigmoid co- lon: a case report and review of the literature. J Med Case Reports 2007; 1: 108. [CrossRef]
• Nicholson JA, Smith D, Diab M, Scott MH, Ann R. Mesenteric panniculitis in Merseyside: a case series and a review of the literature. Coll Surg Engl 2010; 92: 31-4. [CrossRef]
• Belland Neal E, Seymour Schwartz. Schwartz. Principles of Surgery. Ro- bert L.’s 8th editioneds: F.Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, Raphael E. Pollock McGraw-Hill. pp: 1367-8.
• Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, et al. CT evaluation of mesenteric panniculitis: prevalance and associated diseases. Am J Roentgenol 2000; 174: 427-31. [CrossRef]
• Netter FH. The netter collection of medical ıllustrations. Sindirim siste- mi, kısım II. Güneş Tıp Kitabevi. Basım Tarihi 2010; 3: 27.
• Emory TS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, me- senteric panniculitis and mesenteric lipodystrophy: a singleentity? Am J Surg Pathol 1997; 21: 392-8. [CrossRef]
• Aach RD, Kahn LI, French RS. Obstruction of the small intestine dueto retractile mesenteritis. Gastroenterology 1968; 54: 594-8.
• Fujiyoshi F, Ichinari N, Kajiya Y, Nishida H, Shimura T, Nakajo M, et al. Ret- ractile mesenteritis: small-bowel radiography, CT, and MR imaging. AJR Am J Roentgenol 1997; 169: 791-3. [CrossRef]
• Mata JM, Inaraja L, Martin J, Olazabal A, Castilla MT. CT features of mesen- teric panniculitis. J Comput Assist Tomogr 1987; 11: 1021-3. [CrossRef]
• Rosón N, Garriga V, Cuadrado M, Pruna X, Carbó S, Vizcaya S, et al. So- nographic findings of mesenteric panniculitis: correlation with CT and literature review. J Clin Ultrasound 2006; 34: 169-76. [CrossRef]
• Amor F, Farsad M, Polato R, Pernter P, Widmann J, Mazzoleni G, et al. Mesenteric panniculitis presenting with acute non-occlusive colonic ischemia. Int Arch Med 2011; 4: 22. [CrossRef]
• Durst AL, Freund H, Rosenmann E, Birnbaum D. Mesenteric panniculitis: review of the literature and presentation of cases. Surgery 1977; 81: 203-11.
• Ogden WW, Bradburn DM, Rives JD. Mesenteric panniculitis: review of 27 cases. AnnSurg 1965; 161: 864-73. [CrossRef]
• Khachaturian T, Hughes J. Mesenteric panniculitis. Western J Med 1988; 148: 700-1.
• Shah DM, Patel SB, Shah SR, Goswami KG. Mesenteric panniculitis a case report and review of the literature. Indian J RadiolImaging 2005; 15: 191-2. [CrossRef]
• Sabaté JM, Torrubia S, Maideu J, Franquet T, Monill JM, Pérez C. Sclero- sing mesenteritis: imaging findings in 17 patients. AJR Am J Roentgenol 1999; 172: 625-9. [CrossRef]