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Abdominal Radiology

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01-08-2019 | Panniculitis | Review

Demystifying the mesenteric root lesions

Authors: Pawan Kumar, Sundeep Malla, Anuradha Singh, Abdul Razik, K. S. Madhusudhan

Published in: Abdominal Radiology | Issue 8/2019

Abstract

Objective

The aim of this article is to describe the normal anatomy of the root of the small bowel mesentery (RSBM) as well as the multidetector computed tomography (MDCT) features of the various primary and secondary lesions that affect the RSBM.

Results

The small bowel mesentery attaches the jejunum and ileum to the posterior abdominal wall, the line of attachment forming the RSBM. Several primary as well as secondary lesions involve the RSBM. The RSBM has anatomical contiguity with the mesocolon and other peritoneal ligaments, which forms a route for the spread of infection, neoplasms as well as several other abdominal pathologies. MDCT plays an important role in the evaluation of mesenteric root lesions.

Conclusion

Familiarity with the lesions involving the RSBM and their characteristic appearances on MDCT is important in giving thoughtful differential diagnosis and guiding the treating physician in further management.

Jeon YS, Lee JW, Cho SG. Is it from the mesentery or the omentum? MDCT features of various pathologic conditions in intraperitoneal fat planes. Surg Radiol Anat SRA. 2009 Jan;31(1):3–11

Coffey JC, O’Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol. 2016;1(3):238–47

Gray’s anatomy : the anatomical basis of clinical practice - NLM Catalog - NCBI [Internet]. [cited 2018 Dec 16]. Available from: https://www.ncbi.nlm.nih.gov/nlmcatalog/101667594

Coffey JC, Culligan K, Walsh LG, Sehgal R, Dunne C, McGrath D, et al. An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level. Eur Radiol. 2016 Mar;26(3):714–21

Okino Y, Kiyosue H, Mori H, Komatsu E, Matsumoto S, Yamada Y, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiogr Rev Publ Radiol Soc N Am Inc. 2001 Dec;21(6):1475–90.

Yannopoulos K, Stout AP. PRIMARY SOLID TUMORS OF THE MESENTERY. Cancer. 1963 Jul;16:914–27

Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol. 2000 Feb;174(2):427–31

Levy AD, Rimola J, Mehrotra AK, Sobin LH. From the archives of the AFIP: benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation. Radiogr Rev Publ Radiol Soc N Am Inc. 2006 Feb;26(1):245–64.

White B, Kong A, Chang A-L. Sclerosing mesenteritis. Australas Radiol. 2005 Apr;49(2):185–8

10.

Emory TS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: a single entity? Am J Surg Pathol. 1997 Apr;21(4):392–8

11.

Akram S, Pardi DS, Schaffner JA, Smyrk TC. Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2007 May;5(5):589–96; quiz 523–4.

12.

Sharma P, Yadav S, Needham CM, Feuerstadt P. Sclerosing mesenteritis: a systematic review of 192 cases. Clin J Gastroenterol. 2017 Apr;10(2):103–11

13.

Horton KM, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiogr Rev Publ Radiol Soc N Am Inc. 2003 Dec;23(6):1561–7.

14.

Tedeschi CG, Botta GC. Retractile mesenteritis. N Engl J Med. 1962 May 17;266:1035–40

15.

Canyigit M, Koksal A, Akgoz A, Kara T, Sarisahin M, Akhan O. Multidetector-row computed tomography findings of sclerosing mesenteritis with associated diseases and its prevalence. Jpn J Radiol. 2011 Aug;29(7):495–502

16.

Sabaté JM, Torrubia S, Maideu J, Franquet T, Monill JM, Pérez C. Sclerosing mesenteritis: imaging findings in 17 patients. AJR Am J Roentgenol. 1999 Mar;172(3):625–9

17.

Taffel MT, Khati NJ, Hai N, Yaghmai V, Nikolaidis P. De-misty-fying the mesentery: an algorithmic approach to neoplastic and non-neoplastic mesenteric abnormalities. Abdom Imaging. 2014 Aug;39(4):892–907

18.

Katz ME, Heiken JP, Glazer HS, Lee JK. Intraabdominal panniculitis: clinical, radiographic, and CT features. AJR Am J Roentgenol. 1985 Aug;145(2):293–6

19.

Fagkrezos D, Touloumis Z, Giannila M, Penlidis C, Papaparaskeva K, Triantopoulou C. Extra-gastrointestinal stromal tumor of the omentum: a rare case report and review of the literature. Rare Tumors. 2012 Jun 26;4(3):e44

20.

Goh BKP, Chow PKH, Kesavan SM, Yap W-M, Chung Y-FA, Wong W-K. A Single-Institution Experience with Eight CD117-Positive Primary Extragastrointestinal Stromal Tumors: Critical Appraisal and a Comparison with Their Gastrointestinal Counterparts. J Gastrointest Surg. 2009 Jun 1;13(6):1094–8

21.

Nagano Y, Uchida K, Inoue M, Ide S, Shimura T, Hashimoto K, et al. Mesenteric lipoblastoma presenting as a small intestinal volvulus in an infant: A case report and literature review. Asian J Surg. 2017 Jan;40(1):70–3

22.

Tepox Padrón A, Ramírez Márquez MR, Cordóva Ramón JC, Cosme-Labarthe J, Carrillo Pérez DL. Mesenteric schwannoma: an unusual cause of abdominal mass. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig. 2017 Jan;109(1):76–8

23.

Mirshemirani A, Tabari AK, Sadeghian N, Shariat-Torbaghan S, Pourafkari M, Mohajerzadeh L. Abdominal Inflammatory Myofibroblastic Tumor: Report on Four Cases and Review of Literature. Iran J Pediatr. 2011 Dec;21(4):543–8

24.

Minoo P, Wang H-Y. ALK-immunoreactive neoplasms. Int J Clin Exp Pathol. 2012 May 23;5(5):397–410

25.

Coffin CM, Hornick JL, Fletcher CDM. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases. Am J Surg Pathol. 2007 Apr;31(4):509–20

26.

Gleason BC, Hornick JL. Inflammatory myofibroblastic tumours: where are we now? J Clin Pathol. 2008 Apr;61(4):428–37

27.

Gleason BC, Hornick JL. Inflammatory myofibroblastic tumours: where are we now? J Clin Pathol. 2008 Apr;61(4):428–37

28.

Day DL, Sane S, Dehner LP. Inflammatory pseudotumor of the mesentery and small intestine. Pediatr Radiol. 1986;16(3):210–5

29.

Patnana M, Sevrukov AB, Elsayes KM, Viswanathan C, Lubner M, Menias CO. Inflammatory pseudotumor: the great mimicker. AJR Am J Roentgenol. 2012 Mar;198(3):W217-227

30.

Raychaudhari C, Prajapati H, Shah HK. Two cases of immature mesenteric teratoma. Indian J Radiol Imaging. 2006 Oct 1;16(4):567

31.

Chiba T, Iwami D, Kikuchi Y. Mesenteric teratoma in an 8-month-old girl. J Pediatr Surg. 1995 Jan;30(1):120

32.

Al-Arfaj AA, El-Shawarby MA, Al-Mulhim FA, Lardhi AA. Mesenteric cystic teratoma in children. Saudi Med J. 2003 Dec;24(12):1388–90

33.

Burke AP, Sobin LH, Shekitka KM, Federspiel BH, Helwig EB. Intra-abdominal fibromatosis. A pathologic analysis of 130 tumors with comparison of clinical subgroups. Am J Surg Pathol. 1990 Apr;14(4):335–41.

34.

Lotfi AM, Dozois RR, Gordon H, Hruska LS, Weiland LH, Carryer PW, et al. Mesenteric fibromatosis complicating familial adenomatous polyposis: predisposing factors and results of treatment. Int J Colorectal Dis. 1989;4(1):30–6

35.

Smith AJ, Lewis JJ, Merchant NB, Leung DH, Woodruff JM, Brennan MF. Surgical management of intra-abdominal desmoid tumours. Br J Surg. 2000 May;87(5):608–13

36.

Einstein DM, Tagliabue JR, Desai RK. Abdominal desmoids: CT findings in 25 patients. Am J Roentgenol. 1991 Aug 1;157(2):275–9

37.

Brooks AP, Reznek RH, Nugent K, Farmer KCR, Thomson JPS, Phillips RKS. CT appearances of desmoid tumours in familial adenomatous polyposis: Further observations. Clin Radiol. 1994 Sep 1;49(9):601–7

38.

Young RH, Clement PB, McCaughey WT. Solitary fibrous tumors ('fibrous mesotheliomas’) of the peritoneum. A report of three cases and a review of the literature. Arch Pathol Lab Med. 1990 May;114(5):493–5.

39.

Adachi T, Sugiyama Y, Saji S. Solitary fibrous benign mesothelioma of the peritoneum: report of a case. Surg Today. 1999;29(9):915–8

40.

Hashimoto H, Tsuneyoshi M, Enjoji M. Malignant smooth muscle tumors of the retroperitoneum and mesentery: a clinicopathologic analysis of 44 cases. J Surg Oncol. 1985 Mar;28(3):177–86

41.

Tzankov A, Krugmann J, Steurer M, Dirnhofer S. Idiopathic myelofibrosis with nodal, serosal and parenchymatous infiltration. Case report and review of the literature. Acta Haematol. 2002;107(3):173–6.

42.

Holden C, Hennessy O, Lee W-K. Diffuse mesenteric extramedullary hematopoiesis with ascites: sonography, CT, and MRI findings. AJR Am J Roentgenol. 2006 Feb;186(2):507–9

43.

Gordon K, Lee WK, Hennessy O. Computed tomography manifestations of peritoneal diseases. Australas Radiol. 2005 Aug;49(4):269–77

44.

Mindelzun RE, Jeffrey RB, Lane MJ, Silverman PM. The misty mesentery on CT: differential diagnosis. Am J Roentgenol. 1996 Jul 1;167(1):61–5

45.

Stoupis C, Ros PR, Abbitt PL, Burton SS, Gauger J. Bubbles in the belly: imaging of cystic mesenteric or omental masses. RadioGraphics. 1994 Jul 1;14(4):729–37

46.

Ros PR, Olmsted WW, Moser RP, Dachman AH, Hjermstad BH, Sobin LH. Mesenteric and omental cysts: histologic classification with imaging correlation. Radiology. 1987 Aug;164(2):327–32

47.

Hogendoorn W, Schlösser FJV, Sumpio BE. A Giant Superior Mesenteric Artery Aneurysm Mimicking an Abdominal Aortic Aneurysm. AORTA. 2013 Jun 1;1(1):52–6

48.

Strosberg J. Neuroendocrine tumours of the small intestine. Best Pract Res Clin Gastroenterol. 2012 Dec;26(6):755–73

49.

Scarsbrook AF, Ganeshan A, Statham J, Thakker RV, Weaver A, Talbot D, et al. Anatomic and functional imaging of metastatic carcinoid tumors. Radiogr Rev Publ Radiol Soc N Am Inc. 2007 Apr;27(2):455–77.

50.

Chang ST, Jeffrey RB, Patel BN, DiMaio MA, Rosenberg J, Willmann JK, et al. Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care. Radiology. 2016 Jul 20;281(3):816–25

51.

Meyers MA. Intraperitoneal Spread of Malignancies. In: Meyers MA, editor. Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy [Internet]. New York, NY: Springer New York; 1982 [cited 2018 Dec 18]. p. 55–104. Available from: https://doi.org/10.1007/978-1-4757-3958-9_3

52.

Sheth S, Horton KM, Garland MR, Fishman EK. Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiogr Rev Publ Radiol Soc N Am Inc. 2003 Apr;23(2):457–73; quiz 535–6.

53.

Mueller PR, Ferrucci JT, Harbin WP, Kirkpatrick RH, Simeone JF, Wittenberg J. Appearance of lymphomatous involvement of the mesentery by ultrasonography and body computed tomography: the “sandwich sign.” Radiology. 1980 Feb;134(2):467–73

54.

Bernardino ME, Jing BS, Wallace S. Computed tomography diagnosis of mesenteric masses. AJR Am J Roentgenol. 1979 Jan;132(1):33–6

55.

Pantongrag-Brown L, Suwanwela N. Case report: chronic spinal cord compression from extramedullary haematopoiesis in thalassaemia--MRI findings. Clin Radiol. 1992 Oct;46(4):281–3

56.

Kimura T, Inoue T, Katayama K, Hirose K, Imamura Y, Yamaguchi A. Mesenteric Castleman’s disease: report of a case. Surg Today. 2002;32(7):651–4

Title: Demystifying the mesenteric root lesions
Authors: Pawan Kumar
Sundeep Malla
Anuradha Singh
Abdul Razik
K. S. Madhusudhan
Publication date: 01-08-2019
Publisher: Springer US
Keywords: Panniculitis
Computed Tomography
Computed Tomography
Carcinoid Tumor
Panniculitis
Published in: Abdominal Radiology / Issue 8/2019
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-019-02053-9

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