A Case of Recurrent Mesenteric Panniculitis with Large Amount of Chylous Ascites

Yasunori Yoshimoto¹⁾, Ryoichi Shimizu¹⁾, Toshihiro Saeki¹⁾, Yoshinari Maeda¹⁾, Akio Narimatsu²⁾, Akiko Inokuma²⁾ and Mutsuo Takahashi³⁾

¹⁾Department of Surgery, Ogori-Daiichi General Hospital
²⁾Department of Gynecology, Ogori-Daiichi General Hospital
³⁾Basic Laboratory Sciences, Yamaguchi University School of Medicine

We report a patient with mesenteric panniculitis associated with a large amount of chylous ascites recurring after conservative therapy. A 77-year-old woman reporting abdominal fullness was found in abdominal CT to have a large amount of ascites and a shadowy mass with calcification in the mesentery of the small intestine. We conducted surgery to diagnose and treat her under a diagnosis of malignant lymphoma, indicated by elevated soluble IL-2 receptor. Laparoscopic findings showed chylous ascites and a sclerotic, shortened mesentery of the small intestine. The mass in the mesentery was diagnosed as mesenteric panniculitis upon biopsy. Ascites disappeared with conservative treatment. She was readmitted for abdominal fullness about 10 months later. Abdominal CT showed large amount of ascites and lt. hydronephrosis. We conducted a second operation on suspicion of malignancy, since a shadowy mass in the mesentery of the small intestine had enlarged. Laparoscopic findings showed inflammation of the abdominal cavity even severes that at the last operation. Biopsy of the highly sclerotic, mesentery was again diagnosed as mesenteric panniculitis. Her postoperative course was uneventful, and she is being treated as an outpatient with steroid therapy without ascites recurrence.

Key words
mesenteric panniculitis, chylous ascites

Reprint requests
Yasunori Yoshimoto Department of Surgery, Ogori Daiichi General Hospital
862-3 Shimogou, Ogori-cho, Yoshiki-gun, Yamaguchi, 754-0002 JAPAN

Accepted
January 28, 2004

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