What Is Mesenteric Panniculitis (MSP)?
The term “mesentery” comes from the Latin word for “middle.” MSP is a condition where your small intestine becomes inflamed and swollen. The inflammation causes pain, burning sensations, and other symptoms. It may cause blood to leak into the bowel or enter through the skin. If it enters through the skin, then it will bleed easily due to its size. This condition is often referred to as “the middle of the road,” because it’s not really a disease, but rather just a symptom of another one.
When someone has MSP, they have swelling in their small intestine. They may experience pain when eating food, or even vomiting. Sometimes they may feel like they’re going to pass out. There are no specific tests to diagnose MSP, so doctors don’t know what’s causing it.
There is no cure for MSP, but there are treatments available such as:
Medications – These medications help reduce the amount of swelling and pain caused by MSP.
Diet – A diet that is low in fat and high in fiber may help reduce the symptoms. Some people with MSP are lactose intolerant and need to stay away from foods like cheese and milk.
Surgery – In some severe cases, your doctor may recommend surgery to remove part of your inflamed small intestines.
How Is It Treated?
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Mesentery is a thin layer of tissue that attaches your small intestines to the back of your abdominal wall. With MSP, there is an inflammation at this location. It causes swelling and pain in the lower half of your body.
The swelling may also spread to your thighs and groin. This area of the body is called the perineum.
Most people with MSP get pain in their stomachs, sometimes only on one side. Many people have diarrhea. These are signs that your intestines are not working properly.
MSP can also cause a buildup of fluid inside the stomach. The condition is known as ascites.The fluid buildup can cause the stomach to protrude out due to the extra weight.
Risk Factors
You are at a higher risk of getting MSP if you have had disorders such as Crohn’s disease or ulcerative colitis.These are types of inflammatory bowel disease (IBD).
Treatment Options
Treatments usually depend on the type and stage of MSP you have.
Treatments for type 1 include:
During the first few months of treatment, you may be given growth factors to help regenerate the tissue in your small intestines. This process can take time and may not be effective in all patients.
During the next few months, you may take a drug called thalidomide. Thalidomide is known to stop mesenteric angiogenesis (growth of mesenteric blood vessels). It is hoped that by stopping the blood vessel growth, more blood will go back to the heart and the intestines will get a chance to regenerate.
If thalidomide does not work, you may be given low-dose steroids (glucocorticoids). The steroids can reduce the swelling for a while, but the side effects are harmful in the long term.
During the next few months, you may need to have a temporary ileostomy. This involves making a small hole (stoma) in your intestinal wall. A section of your small intestine is brought through the stoma and opened up to allow waste to leave your body. The waste then leaves through a bag outside your body.
Treatments for type 2 include:
Most patients with type 2 do not need treatment. Your doctor may want to observe you over time to check if new blood vessels are growing into the area of damaged tissue.
If you do need treatment, it is the same as for type 1.
After Treatment
Once your symptoms improve, you may be watched over time. If the new blood vessels stop growing after treatment, then there is less chance of complications.
If you have been given an ileostomy, you may need a reversal operation in the next few months if your small intestine heals. The opening in your gut wall will be closed up.
After about a year of treatment, it is hoped that the swelling and inflammation will go down enough to reverse your ileostomy. Small amounts of waste can now pass through your gut wall and out of your body normally through your bowels.
If deglutition of food is impossible (as it may have been during the acute phase), you may be given nutrition and hydration through a PEG tube or a feeding tube directly into your stomach. This will only be temporary as these tubes can cause complications.
What to Expect
With treatment, most people make a full recovery from MSP within 2 years. Without treatment, it can take 10-15 years for the disease to run its course.
After treatment, many people are told to maintain a healthy diet and avoid excessive exercise. It’s also very important that you monitor your blood pressure.
Most people who survive MSP live normal lives, although some people may be more prone to infections.
Prognosis
MSP is not usually life-threatening if it is diagnosed and treated early. If the disease becomes too widespread, it can cause life-threatening conditions. The degree of symptoms and speed of disease progression can vary from person to person.
Treatments
There is currently no known cure for MSP. Treatments aim to manage the symptoms and complications that arise.
The initial treatment for MSP is the same in all patients:
During this time, you will have regular check-ups with your doctor to monitor your symptoms and check for complications. If the disease is in an early stage, your doctor may recommend a treatment called plasmapheresis.
The aim of plasmapheresis is to remove harmful antibodies and plasma from the blood. Fresh blood is pumped out of your body, through a machine which removes the plasma and harmful antibodies, before being returned back into your body.
Most patients with MSP go on to have enteropathy, a severe form of gut disease that affects the small intestine. The exact cause of enteropathy is unknown, and it can be difficult to treat.
After several months or years, most people with MSP develop diabetes due to their pancreas becoming damaged by the disease.
MSP can also affect other internal organs in addition to the gut, such as the liver and kidneys. It can also cause heart disease and stroke.
Most patients who have had MSP for more than 5 years will die from complications related to the disease and its complications.
The chart below shows the survival rates for patients with MSP in different stages. It shows that if the disease is caught early, the chances of dying are reduced significantly.
Stages of MSP
There are 4 stages of MSP.
The first stage is the prodrome stage, which lasts between 2 weeks and 6 years. During the prodrome stage there are typically no noticeable symptoms. However, there may be minor symptoms such as fatigue, mild itching, or mild discomfort. It is also during this time that antibodies for MSP-A become detectable in the blood.
The appearance of these antibodies in the blood is an early sign that the disease is developing, even if there are no other symptoms.
The second stage, known as the latent stage, lasts from 6 months to 5 years. During this time there are typically no noticeable symptoms.
Around 80% of people who have been through the prodrome stage will progress to the third stage, known as the residual stage. This can occur anytime between 5 and 30 years after the appearance of antibodies in the blood.
The residual stage is when the disease has spread to the liver and spleen, causing enlargement of these organs. The enlargement of these organs can cause complications such as internal bleeding.
The final stage of MSP, known as the active stage, occurs when the disease progresses and starts damaging vital organs, such as the pancreas and heart. There are no symptoms during this stage.
Death usually occurs within a year or two after the symptoms appear.
The stages of MSP can be detected through blood tests. Occasionally, an MRI scan or CT scan may be used to detect abnormal enlargement of the spleen or liver.
You should see your doctor as soon as possible if you have been identified to have antibodies for MSP-A in your blood. Early detection and treatment can help prevent the disease from becoming serious.
Due to the risk of death being so high, most health insurance companies consider MSP a “rare disease” and, as such, cover the cost of treatment.
Your doctor will first perform a physical examination on you, looking for symptoms such as enlargement of the spleen or liver, inflammation of the pancreas, and an enlarged heart. They may also order blood tests to look for the presence of specific antibodies that are associated with MSP.
The treatment of MSP is mostly supportive. This means that the symptoms of the disease are treated, but no specific treatment is designed to target the underlying disease.
Mild cases of MSP are sometimes treated with steroids such as prednisolone and azathioprine. These drugs suppress the immune system, and can reduce or eliminate the symptoms of the disease. However, the steroids can have many side effects. These side effects usually subside after the drug is discontinued.
Severe cases of MSP are treated using chemotherapy drugs, such as cyclophosphamide and chlorambucil. These drugs support your immune system by suppressing the proliferation of abnormal plasma cells.
Splenectomy may be performed if there is an enlarged spleen, and a liver biopsy may be performed if there is evidence of liver damage.
The treatment of MSP is different for each individual, and may include a combination of the above treatments. The treatment plan is developed by your physician based on your medical history, physical examination, and laboratory findings.
Living and Management
There is no cure for multiple myeloma; however, the disease can be managed with treatment. Your doctor will likely follow your condition by performing blood tests periodically to check for the presence of MSP-A in the blood. The treatment of this condition is based on the presence and severity of the symptoms.
The disease progresses slowly over many years. Most patients can live for years after diagnosis. You should remind your doctor if you notice any symptoms of MSP, such as bone pain or fractures, fevers, infections that do not respond to antibiotics, or easy bleeding. You may eventually experience renal failure and respiratory failure as the disease progresses.
These conditions can be managed with dialysis and chemotherapy.
Unnecessary exposure to infections should be avoided. Immunizations (such as annual flu vaccines) may decrease your body’s resistance to infection and are usually not given to people with untreated MSP.
Once the disease is in remission, most patients can lead a relatively normal life.
Maintaining a healthy diet and getting plenty of exercise may help slow the disease’s progression. Patients who are able to maintain normal weight have been shown to live longer with the disease. Chemotherapy and radiation therapy may be used to treat any painful or life-threatening symptoms.
“Stem cell transplant” has also been a topic of research for patients who have not responded to standard therapies. The goal of this treatment is to replace the patient’s bone marrow with healthy bone marrow stem cells.
As of now, there is no standard protocol for the treatment of this disease. The goal of ongoing research is to find better ways to diagnose, prevent, and treat MSP.
The only thing that is certain about multiple myeloma is that there is a lot more yet to be discovered.
Note: MULTIPLE MYELOMA (M.S.P) will not respond well to steroids or any other immunosupressive drugs, and at best they MAY give you some relief from the symptoms but the cancer will continue to grow .
Note: If you have any doubts contact a competent oncologist or Hematologist for advice.
Cancer is as Catchable as Any Other Disease!
I think I got it from handling used Cars that had ‘leaky’ Air-Bag Systems!
Maybe the mechanic should have worn rubber gloves…
Whichever it was, it was around 1995 when I first had symptoms.
I didn’t really pay attention to the pains and aches, as I was still working full on and just thought that I was ‘getting old’ So a couple of years later after a fall where I broke my wrist, (after hitting my head) was taken straight to hospital where a rheumatologist started treating me for arthritis.
I didn’t really think too much of it at the time, except that they were giving me lots of pills to swallow, and even had physiotherapy for my stiff aching limbs.
The pains were still there however even after finishing the course of tablets, so I went back to the hospital where they took lots of blood tests and then told me I had to see a Haematologist.
By this time I was feeling really unwell, with constant fevers and night sweats. My muscles had started to atrophy and I had started to get bone pain all over my body.
This new doctor told me that I had ‘Multiple Myeloma’ a type of tumor affecting the bones, and that they would start treatment immediately after my blood tests came back.
I was relieved to finally have a diagnosis, but very apprehensive about the strong chemotherapy drugs that were to start immediately.
I felt like I had been hit by a truck when the drugs started to take affect, I couldn’t even keep water down and spent a whole night throwing up.
Fortunately this was a ‘Red’ Alert emergency, and they had given me the minimum effective dose for the starters, so after a few days of recovery I was able to go home with instructions to come back after 2 weeks for the full treatment.
I spent the next few weeks sleeping and feeling very sorry for myself, but after the second treatment I felt a lot better and able to start eating again.
I returned to work after about 4 weeks, but I had lost a lot of weight and was still very tired all the time.
As the months went by, I slowly improved and got back most of my strength and energy.
I had one more course of treatment including high intensity Chemotherapy and several courses of very strong immuno-suppressant drugs.
I felt a little ill for a while after each treatment, but the side-effects were no where near as bad as I had been told to expect.
I was in regular contact with my doctors in the months after finishing treatment, and it looked like they had got it all just in time.
It’s now been 15 years and I’m still one of the ‘living’ cases that make the medical textbooks!
I’m fat, bald and bloated because of the steroids, but I’m still alive!
Life is very different now though, I have to take lots of drugs every day and they make me feel constantly ‘full’ but at least I’m here to take them!
I still work in the same job, and apart from my appearance nobody would know that I’m a ‘Leukemia’ survivor.
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Mesenteric panniculitis resulting in bowel obstruction: response to steroids by CS Kikiros, AJ Edis – Australian and New Zealand Journal of …, 1989 – Wiley Online Library
Successful management of symptoms of steroid-dependent mesenteric panniculitis with colchicine by I Iwanicki-Caron, G Savoye, JR Legros… – Digestive diseases and …, 2006 – Springer
Successful steroid therapy for postoperative mesenteric panniculitis by H Miyake, T Sano, J Kamiya, M Nagino, K Uesaka… – Surgery, 2003 – surgjournal.com
CT evaluation of mesenteric panniculitis: prevalence and associated diseases by M Daskalogiannaki, A Voloudaki… – American journal of …, 2000 – Am Roentgen Ray Soc
Mesenteric panniculitis by G Piessen, C Mariette, JP Triboulet – Annales de chirurgie, 2006 – ncbi.nlm.nih.gov
