Mesenteric Panniculitis Presenting With Atypical Abdominal Pain: A Case Report

Mesenteric panniculitis (MP) is a rare, idiopathic inflammatory disorder of the mesenteric adipose tissue that often mimics other GI conditions, including malignancy, making diagnosis challenging. We present the case of a 77-year-old woman with a history of atrial fibrillation, hypertension, and mild heart failure who was admitted with an eight-day history of abdominal pain localized to the hypogastric region and unintentional weight loss of 6 kg over four months. On admission, her vital signs were stable, and laboratory tests, including CRP, were within normal limits. Abdominal X-ray revealed no abnormalities; however, CT demonstrated a "misty mesentery" appearance with scattered lymphadenopathy, consistent with MP. Colonoscopy excluded malignancy and other colonic pathology, and biopsy was deemed unnecessary. The patient was treated with oral glucocorticoids and analgesics, which led to substantial relief of abdominal symptoms within 72 hours. At three-month follow-up, she reported resolution of abdominal pain, weight gain, and stable laboratory results. A six-month CT scan demonstrated stable mesenteric findings, and she remains under annual surveillance. This case highlights the diagnostic challenge of MP due to its nonspecific clinical manifestations and frequent overlap with malignant conditions. CT is the imaging modality of choice, with characteristic features such as "misty mesentery" or "fat-ring sign" aiding differentiation. Most cases are managed conservatively, with glucocorticoids providing effective symptom relief. Awareness of this entity among clinicians is essential to prevent misdiagnosis and avoid unnecessary invasive investigations or surgical interventions.