Mesenteric panniculitis in Merseyside
Description
◉ Patient A
• The woman is 65 years old.
• Presentation: Obese; mild RUQ soreness; peri-umbilical fullness (intraperitoneal); long history of nonspecific right upper quadrant (RUQ) and peri-umbilical pain.
• Investigations:
• Bilirubin level: 28 μmol/L, somewhat icteric.
• Ultrasound: biliary tree in normal condition.
• CT: mesentery root heterogeneous mass → typical mesenteric panniculitis findings.
• Diagnosis: Radiological.
◉ Demographics: male, age 62.
• Presentation: palpable central abdominal mass, nausea, anorexia, and abdominal pain for one month.
• Investigations:
• Except for the ESR of 21 mm/hr, bloods are normal.
• CT: typical symptoms of mesenteric panniculitis.
• Imaging revealed a "pseudotumour stripe" and mesenteric vascular displacement rather than invasion.
• Histological confirmation following laparoscopic biopsy.
• Diagnosis: Mesenteric panniculitis with histological confirmation.
◉ Individual C
• The woman is 68 years old.
• Presentation: stomach discomfort, anemia, and malaise.
• Investigations:
• Bloods: Hb 11.2 g/dl, or hypochromic anemia.
• Exam: not noteworthy.
• Colonoscopy: negative (colonic cancer was suspected at first).
• CT: panniculitis of the mesentery.
• Diagnosi•s: Radiological mesenteric panniculitis after exclusion of malignancy.
◉ Patient D
• Demographics: Barrett's oesophagus with hiatus hernia in a 63-year-old guy.
• Presentation: Central abdominal and epigastric discomfort leading to emergency admission.
• Investigations:
• Bloods: normal except for CRP of 55 mg/L.
• X-rays: typical.
• First treatment: released on higher PPI.
• The CT abdomen showed mesenteric panniculitis (small bowel mesentery root) at 10 × 4 cm.
• Histology was verified by biopsy.
• Four months later, the follow-up CT showed a noticeable reduction in size.
• Histological confirmation of the diagnosis revealed partial spontaneous regression.
• Review of Literature and Discussion
• Presence: around 1% (based on over 700 autopsy).
• Demographics: M:F = 1.8:1 indicates a slight male predominance.
• The cause is unknown. Proposed connections:
• Ischemia, trauma, and infection.
• Weber-Christian illness, or vasculitis.
• Granulomatous illness.
• cancer.
• pancreatitis.
• Systemic lupus erythematosus, occupational vibration trauma, and tuberculosis are uncommon relationships.
• Not connected to: Previous abdominal surgery or inflammatory bowel illness.
◉Clinical Presentation
Symptoms include fatigue, nausea, changed bowel habits, and vague abdominal pain or fullness (central or RUQ).
Rectal hemorrhage is uncommon.
Signs: Often RUQ, a poorly defined abdominal lump.
Laboratory results: Usually normal, but may indicate non-specific anemia and ↑ ESR (~60% of cases).
◉ Investigations
• Imaging:
• CT scan: most dependable; occasionally used alone for diagnosis.
• Results: pseudotumoural stripe, displacement (not invasion) of mesenteric arteries, sporadic thickening of the gut wall, and heterogeneous encapsulated mesenteric mass.
• Barium/X-ray: Ineffective.
• Doppler/ultrasound: Not specified.
• The gold standard for histology is:
• Macroscopy: nodule, diffuse, or enlarged mesentery (replicates lymphoma or cancer).
• Microscopy: inflammatory infiltrates (monocytes, lymphocytes, lipid-laden macrophages, large cells), foamy histiocytes, and fat necrosis.
Protocol
•Management & Natural Course
•Course: Frequently restricts itself. Some people (like Patient D) regress on their own.
•Follow-up: After three to five months, many lesions show no change on a follow-up CT scan.
•Treatment options:
•Asymptomatic/mild observation.
•Immunosuppressants and corticosteroids (no RCTs, some claims of improvement).
•surgery infrequently (primarily for problems or doubt in diagnosis).
• Problems Faced in Clinical Settings
• Acute or chronic pain, infections (including infections linked to healthcare), complications from long-term conditions(diabetes, hypertension), and pressure ulcer risk are some of the difficulties that patients may face.
• Numerous sources of pain and suffering necessitate immediate and continuous care.
• the risk of infection as a result of underlying diseases or invasive procedures.
• Chronic disease complications necessitate ongoing monitoring and lifestyle modifications.
• Patients who are immobilized are at risk for pressure ulcers.
Management Strategies
• Thorough assessment, customized care plans, and evidence-based interventions are the first steps towards effective management:
• Assessment: Determining the severity and patient-specific requirements using instruments (such as pain ratings, skin, and risk evaluations).
• Care planning is the process of creating patient-centered plans that list interventions and prioritize difficulties.
•Interventions in Nursing
•The following are comprehensive nursing interventions, arranged according to the treatment approach and problem encountered:
• Pain Control
• Use standardized measures to gauge the degree of pain.
• Administer analgesics as directed and keep an eye out for adverse effects.
• Use non-pharmacological comfort measures, such as physical therapy, massage, and relaxation techniques.
• Preventing Infections
• Adopt stringent hand hygiene guidelines.
• Make proper use of personal protective equipment (PPE).
• Inform patients and their families about the dangers of infections and how to avoid them.
• Monitoring of Chronic Illnesses
• Maintain routine blood pressure, glucose, and other pertinent parameter monitoring.
• Make sure that medication schedules are followed.
• Inform consumers about possible difficulties, exercise, and food choices.
•Prevention of Pressure Ulcers
•Patients should be repositioned frequently.
•Make use of support surfaces, such as cushions and special mattresses.
•Check your skin frequently and take care of it using moisturizers and barrier creams.
Notes
For more details visit:https://pmc.ncbi.nlm.nih.gov/articles/PMC5696871/?utm_source=chatgpt.com
