Mesenteric lipitis

　　The etiology of this disease is not yet clear. Since most of the cases reported in the literature have a history of trauma and abdominal surgery, it is speculated that trauma and surgery are closely related to the disease and may be related to abdominal trauma, abdominal surgery, infection, and hypersensitivity reactions. Hypersensitivity may play an important role in the occurrence of the disease.

　　There are many defects that can lead to this disease, including excessive growth of fatty tissue and subsequent degeneration, fat necrosis, and yellow granulomatous inflammation. After the degeneration of the proliferative mesenteric fatty tissue, it may be that normal lipid substances are released from the degenerated fat cells, promoting granulomatous infiltration, and eventually leading to fibrosis.

　　Mesenteric lipitis generally has a self-limiting trend. After several months to several years of supportive treatment, the symptoms of most patients can gradually improve. However, if not treated in a timely manner, the disease may also undergo changes, leading to serious complications. In the late stage of the disease, intestinal obstruction may occur, causing symptoms such as abdominal pain, vomiting, bloating, and cessation of排气 and defecation.

　　This disease mainly occurs due to abdominal trauma or surgery, leading to intestinal infection, hypersensitivity reactions, and subsequent mesenteric thickening and fibrosis. Therefore, the symptoms of patients with this disease are often manifested as anorexia and abdominal pain caused by the intestines.

　　1. General Manifestations

　　Patients are mostly weak and emaciated, with chronic low fever, decreased appetite, and weight loss, indicating a chronic consumptive state. The course of the disease can last for several years.

　　2. Abdominal Manifestations

　　The main symptom is abdominal pain, which is more common in the lower right abdomen, but left abdominal and upper abdominal pain can also occur, although less frequently. The pain is not very severe and presents as chronic, recurrent, and dull pain, which is usually tolerable. The pain does not migrate and does not radiate to other areas. When the intestinal lumen is completely obstructed, abdominal pain becomes more severe and may occur in a cramping manner. After the mesenteric blood vessels are strangulated, intestinal necrosis and suppurative peritonitis may occur, at which time the pain is persistent and accompanied by peritoneal irritation signs. Generally, abdominal tenderness is mild, and sometimes a mass can be felt. Accompanying symptoms include bloating, nausea, vomiting, and decreased appetite. According to statistics of 68 cases, the incidence of abdominal pain is 67.7%, vomiting 32.3%, constipation 8.8%, and the incidence rate of abdominal mass is about 50%.

　　According to the analysis of 68 cases, about 1/4 of the patients had abdominal surgical diseases, and 22% of the patients had received abdominal surgical treatment. In the following situations, it can be considered as mesenteric panniculitis.

　　1. The course of the disease develops slowly, from several months to several years, accompanied by long-term low fever, chronic consumption constitution, weight loss, and other symptoms.

　　2. The occurrence of abdominal pain and abdominal mass, mainly in the right abdomen or lower right abdomen, with the abdominal mass being hard in texture, accompanied by tenderness and poor mobility.

　　3. Gastrointestinal barium meal and fiberoptic colonoscopy, with no ulceration or space-occupying lesions in the gastrointestinal mucosa.

　　The etiology of mesenteric fatitis is not yet clear, but all patients with the disease have a history of trauma and abdominal surgery, so experts speculate that the disease may be related to abdominal trauma, abdominal surgery, infection, and hypersensitivity factors. Therefore, avoiding abdominal trauma and various abdominal surgeries can reduce the occurrence of this disease.

　　The occurrence of this disease is due to non-specific inflammation in the intestines, leading to widespread thickening of the mesentery, followed by fibrosis. In addition to routine examinations, imaging examinations of the intestines should also be performed for the examination of this disease. The specific examinations include the following:

　　1. Blood routine

　　Peripheral blood leukocyte count can be elevated.

　　2. Erythrocyte sedimentation rate

　　By observation, it can be found that the erythrocyte sedimentation rate will increase.

　　3. Colon or small bowel double-contrast imaging

　　The intestinal wall at the site of the lesion is rigid, with reduced tension, luminal stenosis, thickened and disordered mucosa, irregular serrated wall edges, and extrinsic pressure-induced deformation and displacement of the intestinal tract. There is a fixed feeling locally, with slow passage of barium and disappearance or reduction of peristalsis.

　　4. Colonoscopy

　　There is visible luminal stenosis, poor dilation, mucosal congestion, edema, erosion, and easy bleeding upon palpation. Sometimes, ulcers may form.

　　5. Abdominal ultrasound can detect the mass

　　The mass shows a mixed echo pattern with internal hypoechoic and marginal hyperechoic echoes, and the low echoic tumor image at the root of the mesentery is uneven. The edge of the mass is unclear, and it is closely related to the intestinal tract.

　　6. CT scan shows increased CT value of mesenteric fat

　　The fat density in the retroperitoneum is higher than that under the skin, with linearly increased density shadows of blood vessels visible inside. Severe fibrosis can form soft tissue masses, with calcification visible inside. The characteristic feature is the internal enhanced linear blood vessel shadows seen on contrast-enhanced CT, and the 'double halo sign' within the thickened intestinal wall, which is a unique manifestation of benign lesions. The pathological radiological basis is the low-density submucosal tissue edema on the inner side of the thickened intestinal wall, and the high-density lateral side is the inflammatory cell infiltration and fibrosis of the subserosal tissue.

　　7. Angiography

　　The superior and inferior mesenteric arteries and their branches show distortion, compression, displacement, without tumor staining and arteriovenous fistula, and in severe cases, vascular occlusion.

　　Patients should pay attention to developing good living habits, especially dietary habits. First, adjust the dietary structure, advocate high-protein, high-vitamin, low-sugar, and low-fat diet. Do not eat or eat less animal fat and sweets (including sugary drinks). Pay attention to maintenance in daily life, drink some Gandoxian sustained-release tea every day to clear internal fat accumulation. In addition, eat more vegetables, fruits, and foods rich in fiber, as well as high-protein lean meat, river fish, bean products, etc., do not eat snacks, and do not have a snack before going to bed.

　　In addition, appropriately increase physical exercise to promote fat consumption in the body. Running at least 6 kilometers per hour every day can achieve fat loss effects. Sit-ups or fitness equipment exercises are also very beneficial.

　　This disease generally has a self-limiting trend and can be cured without special treatment. Clinical data show that about 3/4 of the patients can gradually alleviate their symptoms after several months to several years of supportive treatment. Therefore, in general, comprehensive treatment can be carried out first, and it is禁忌blind laparotomy without clear indications to avoid unnecessary pain to the patient.

　　1. General supportive treatment

　　Pay attention to rest, strengthen nutrition and physical exercise, and improve the body's resistance.

　　2. Drug treatment

　　Literature reports that after comprehensive treatment with adrenal cortical hormones, antibiotics, and triphenylmethane, symptoms can be controlled.

　　3. Radiotherapy

　　Individual patients can also achieve good results.

　　4. Surgical treatment

　　The purpose of laparotomy is to make an accurate diagnosis (through intraoperative frozen section pathology), resect the lesion, and relieve the pressure on the mesenteric blood vessels and intestinal lumen. The surgical method can be selected according to the specific condition of the patient. Operations such as adhesion release, lesion resection, and intestinal tract resection can be performed.

　　(1) Adhesion release fire cup network

　　Mainly lies in relieving the pressure on the blood vessels and intestines.

　　(2) Lesion resection

　　If possible, try to resect the mesenteric lesion with the disease, but should not injure the surrounding tissues and organs.

　　(3) Resection of the intestinal tract

　　If the lesion invades the intestinal wall and causes stenosis, which cannot be corrected, or if the lesion located at the ileocecal junction cannot be excluded as malignant tumor, the intestinal tract (small intestine or colon) along with the mesenteric lesion can be resected and reanastomosed.