Mesenteric panniculitis is a rare, benign and chronic fibrosing inflammatory disease that affects the adipose tissue of the mesentery. Clinical symptoms of mesenteric panniculitis are highly variable. Due to its variable clinical presentation and rarity, the diagnosis of mesenteric panniculitis is often delayed or missed. Here we present a rare presentation of mesenteric panniculitis, i.e. right iliac fossa tenderness mimicking acute appendicitis. This report describes the case of a 59-year-old female who presented to the ER with acute abdominal pain and vomiting. The pain was initially localised to the epigastric region but subsequently migrated to the right iliac fossa (RIF) region. The patient was clinically diagnosed with Acute Appendicitis and scheduled for pre-anaesthetic check-up and elective surgery. Meanwhile, an ultrasound was performed which was found to be inconclusive and the contrast enhanced CT scan showed a long appendix which wasn’t inflamed. Instead, the CT revealed signs of Mesenteric Panniculitis. The surgery was cancelled and she was treated conservatively. The patient clinically improved, her right iliac fossa tenderness decreased in severity and finally disappeared. She was then discharged in a stable hemodynamic condition with advice to follow up with a repeat CECT whole abdomen after 6 months.

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Dr Devpriyo Pal

Postgraduate Trainee, MD Radiology, North Bengal Medical College, Darjeeling