Skip to main content
Download PDF

Massive mesenteric panniculitis due to fibromuscular dysplasia of the inferior mesenteric artery: a case report

BMC Gastroenterology volume 15, Article number: 71 (2015) Cite this article

Abstract

Background

Fibromuscular dysplasia (FMD) is a nonatheromatous, noninflammatory arterial disorder of unknown etiology resulting in vessel stenosis and/or aneurysm formation. The renal and cephalocervical (mainly carotid arteries) arterial beds are classically involved; involvement of visceral arteries is rare. Mesenteric panniculitis (MP) is an inflammatory process of mesenteric fat considered to be of unknown etiology. The majority of cases involve the small bowel mesentery; colorectal MP is rare. To our knowledge, no example of MP due to FMD has been described.

Case presentation

A 52 year old man presented with steadily worsening lower abdominal pain. Investigation revealed ischemic rectosigmoid mucosa associated with a large mesenteric mass of unknown nature. Angiography showed the disease was limited to the distribution of the inferior mesenteric artery. Subsequent symptoms of large bowel obstruction necessitated a left hemicolectomy. Pathologic examination showed bowel wall necrosis and massive panniculitis of the rectosigmoid due to FMD. Subsequent angiographic imaging of other vascular beds was negative.

Conclusions

Several features of this case are noteworthy: FMD limited to the inferior mesenteric artery has not been previously reported, FMD has not previously been implicated as a cause of MP, and the massive extent of panniculitis. An accompanying literature review of cases of visceral FMD, traditionally believed to almost exclusively affect females, highlights a greater than anticipated number of males (33 %), and a gender difference regarding concomitant involvement of cephalocervical and/or renal vascular beds (32 % in males versus 80 % in females). The latter observation may have implications regarding the value of radiologic screening of other vascular beds, particularly in asymptomatic males, in patients presenting with visceral artery FMD.

Peer Review reports

Background

Fibromuscular dysplasia (FMD) is a nonatheromatous, noninflammatory arterial disorder of unknown etiology resulting in vessel stenosis and/or aneurysm formation [1]. The renal and cephalocervical arterial beds are classically involved. Involvement of visceral arteries is rare. Mesenteric panniculitis (MP) is an inflammatory process of mesenteric fat, also considered to be of unknown etiology [2]. The small intestinal mesentery is by far the most common site; the colorectal mesentery is less commonly involved [2]. This case describes massive colorectal MP due to FMD of the inferior mesenteric artery (IMA), representing a unique association of two rare entities (Additional file 1).

Case presentation

A 52-year old man came to the emergency department after ten days of steadily worsening crampy pain in the left flank and iliac fossa. His medical history was unremarkable. He had stopped smoking ten years previously (15 pack-years). The temperature was 38.8 C. Physical examination of the lower abdomen elicited some guarding, but the abdomen was otherwise supple with no palpable mass. The leucocyte count was normal. He was admitted to hospital.

An abdominal CT scan showed features compatible with colitis, probably ischemic, extending from the splenic angle to the rectum. The bowel wall was thickened with “infiltration” of the surrounding fat. A 3 cm left renal mass was also noted. Although colonoscopy showed colitis of irregular distribution, perhaps infectious, a biopsy specimen revealed normal colonic mucosa. The patient was discharged with a prescription for an antibiotic.

Four days later he returned to the emergency department with pain similar to that at his first admission. He was admitted to hospital. A CT scan was performed (Fig. 1) which showed a markedly thickened mesentery and a thickened, non-enhancing left colonic wall. The inferior mesenteric artery was irregular, tortuous and stenosed; there was no intravascular thrombosis. Based on these findings, vasculitis was initially considered. Colonoscopy showed marked edema of the mucosa. A biopsy specimen showed ischemic changes.

Fig. 1
figure1

Computerized tomography images in arterial phase acquisition: a) Axial (1 mm slice thickness) showing fat stranding (black arrows) and thickened sigmoid wall (short thick arrows). b Coronal reconstruction (maximal intensity projection [MIP] slice thickness 7 mm) showing thickened recto-sigmoid wall (short thick arrow), and abnormal irregular and dilated distal vessels arising from the inferior mesenteric artery (thin arrow). c Sagittal reconstruction (MIP slice thickness 5 mm) showing multiple tortuous vessels (thin arrows) and hyperemic thickened mesocolon (arrow heads)

Full size image

Three weeks later a diagnostic laparoscopy was performed which found ascites and multiple whitish epiploic appendices, one of which was biopsied with a subsequent microscopic diagnosis of fat necrosis. A loop colostomy was performed.

Six weeks later symptoms of large bowel obstruction developed; a left hemicolectomy with transverse colostomy was therefore performed. During the same intervention a left partial nephrectomy was carried out. The rectal stump was left open with a drain.

Pathologic findings

The renal mass showed microscopic features characteristic of an oncocytoma.

Macroscopic examination of the recto-sigmoid resection specimen (Fig. 2) showed diffuse hemorrhagic necrosis of the mucosa and marked bowel wall thickening with massive mesenteric necrosis. Necrotic fat encased the whole length of the resected bowel.

Fig. 2
figure2

Macroscopy of the resected recto-sigmoid colon: a) Longitudinal view. The necrotic mucosa is covered by an extensive inflammatory pseudo-membrane. The mesentery shows diffuse fat necrosis (panniculitis). b and c Cross sectional views. The colonic wall is thickened and edematous. There is extensive mesenteric fat necrosis. Normal fat is seen at right

Full size image

Microscopic examination (Fig. 3) confirmed marked ischemia and ulceration of the colonic mucosa. The mesentery showed findings typical of fat necrosis. Numerous arteries and arterioles within the necrotic fat were obstructed to varying degrees, often completely, by fibrosis of the intima; the media of these vessels was normal. Atheromata, thrombosis, and inflammation were absent. The changes were considered diagnostic of fibromuscular dysplasia, intimal-type.

Fig. 3
figure3

Histology of the resected recto-sigmoid colon: a) Scanning power view of the ulcerated mucosa with adjacent normal colonic epithelium. b and c Scanning power views of the extensively necrotic mesentery. Viable (b) and ulcerated (c) colonic mucosa are seen respectively (arrows). d Medium power view of colonic epithelium showing acute ischemia characterized by epithelial loss with fibrosis and multiple micro-thromboemboli within the lamina propria. e Medium power view of necrotic mesentery with numerous foamy macrophages. Fibrosis is absent. A medium-size vessel shows nearly complete fibrous obliteration of the lumens. f, g, h, i, j High power views of medium size mesenteric arteries with fibrous intimal proliferation leading to near-complete luminal occlusion: hemotoxylin-phloxin-saffrin (f, g) and Verhoff Von Geason (h, i, j), the latter highlighting arterial internal elastic lamina

Full size image

The postoperative course was uneventful and the patient was discharged home. Ten months later, he is asymptomatic and he is due to have his colostomy reversed.

Conclusions

Fibromuscular dysplasia (FMD) involving visceral arteries in adults is rare (or rarely reported), with only 75 well-documented cases published since 1963 (Table 1). This is the first documented case of mesenteric panniculitis (MP) of the rectosigmoid colon due to visceral artery FMD. Two features are notable: limitation of involvement to the distribution of the inferior mesenteric artery, and the “massive” extent of the panniculitis.

Table 1 Reported cases of adult (greater to/equal 18 y of age) visceral artery fibromuscular dysplasia
Full size table

Mesenteric panniculitis (MP) is a rare inflammatory disorder leading to “tumorlike” enlargement of the mesentery, the vast majority of cases involving the small bowel [2, 3]. It is characterized by variable degrees of fat necrosis, chronic inflammation and fibrosis. This histologic variability has resulted in other terms which reflect the dominant morphologic finding, including sclerosing mesenteritis and mesenteric lipodystrophy [2]. Numerous clinical associations have been noted and there are many theories regarding etiology [3]. No unifying pathophysiologic mechanism has been elucidated, likely because it is the result of a number of disease processes.

FMD is defined as a “nonatheroscleotic, noninflammatory vascular disease that may result in arterial stenosis, occlusion, aneurysm, or dissection [1]”. The renal and cervicocranial (CC) vascular beds are classically involved [1]. A landmark consensus histologic classification of renal artery FMD was published in 1971, emphasizing the vessel layer involved [4]: 1) intimal fibroplasia (1-2 % of cases), 2) medial, of which there are four subtypes: medial dysplasia with mural aneurysm (60-70 %), medial hyperplasia (5-15 %), perimedial fibroplasia (15-25 %), medial dissection (5-10 %), and 3) periarterial fibroplasia (less than 1 %). Subsequent experience has shown that intimal FMD is more common than was appreciated in 1971, and that there are reliable angiographic correlates to these histologic subtypes [1]. It is noteworthy that the opportunity for microscopic examination of involved vessels in suspected FMD is now exceptional: in a recent review of 447 patients, tissue for pathologic analysis was available in only 3.3 % of cases (from all vascular beds). The diagnosis is now established in essentially all cases by angiographic and noninvasive imaging [1].

The angiographic appearance of medial FMD is classically described as “string-of-beads” (typical FMD) [5] and is secondary to medial thickening causing luminal stenosis, alternating with zones of mural thinning and dilatation (aneurysms), the latter associated with loss of the internal elastic lamina [1, 4, 5]. In certain vascular beds, and, of note, the mesenteric vessels, the string-of-beads change is less frequent. Rather, the angiographic appearance is one of tubular constriction (atypical FMD) [1, 5], which correlates with intimal involvement, such as was present here. Thus, absence of the string-of-beads sign should not reflexively rule out a diagnosis of FMD.

A 2014 consensus document [6] recommends, when either renal or cervicocranial FMD is discovered, screening of the “other” vascular bed provided identification of any new lesion will modify the patient’s management. The authors extend this recommendation to screening of “less often involved vascular beds” only when there are suggestive symptoms or a suggestive medical history. Angiographic imaging had revealed no involvement of the renal arteries in our patient. In light of the diagnosis of FMD of a major visceral artery, angiographic study of the CC vessels was subsequently performed which revealed no abnormality. In retrospect, this might have been expected as our summary of the reported cases of FMD of visceral arterial beds (Table 2) shows that only 12 % of males with visceral FMD had CC involvement.

Table 2 Summary of reported cases of visceral fibromuscular dysplasia
Full size table

Table 2 also highlights that, although the earliest reports show an overwhelming majority of cases occurring in females, later cases document many more males with visceral FMD, such that men now represent one third of cases. There is also a gender difference regarding associated CC and renal artery involvement: concomitant CC and/or renal artery disease was present in 80 % of females, whereas these vessels were involved individually or together in 32 % of men. Involvement of the IMA is highly unusual; indeed, we describe the first case in which disease is limited to this artery.

Of note, regarding the reported cases of visceral FMD, we must mention an extraordinary publication from 2005 [7] which tallies 30 cases of FMD of the SMA from one Parisian clinic alone, which would thus account for more than one third of all the reported cases retrieved through the PubMed database. As this uniquely vast experience does not sufficiently detail individual patients and includes presentations not described elsewhere (e.g. SMA dissection in eight patients), we have chosen to exclude it from the table.

In conclusion, we describe FMD as the etiology of a case of massive colorectal MP. FMD of visceral arteries may have “atypical” clinical and radiologic features, and, although a rare entity, should be considered when MP is diagnosed.

Consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Abbreviations

CC:

Cephalocervical

FMD:

Fibromuscular dysplasia

MP:

Mesenteric panniculitis

SMA:

Superior mesenteric artery

IMA:

Inferior mesenteric artery

References

  1. 1.

    Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, et al. The United States Registry for fibromuscular dysplasia. Results in the first 447 patients. Circulation. 2012;125:3182–90.

    Article  PubMed  Google Scholar 

  2. 2.

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

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Akram S, Pardi DS, Schaffner JA, Smyrk TC. Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin Gastroenterol Hepatol. 2007;5:589–96.

    Article  PubMed  Google Scholar 

  4. 4.

    Harrison EG, McCormack LJ. Pathologic classification of renal artery disease in renovascular hypertension. Mayo Clin Proc. 1971;46:161–7.

    PubMed  Google Scholar 

  5. 5.

    Lüscher TF, Lie JT, Stanson AW, Houser OW, Hollier LH, Sheps SG. Arterial fibromuscular dysplasia. Mayo Clin Proc. 1987;62:931–52.

    Article  PubMed  Google Scholar 

  6. 6.

    Persu A, Giavarini A, Touzé E, Januszewicz A, Sapoval M, Azizi M, et al. European consensuson the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2014;32:1367–678.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Cormier F, Cormier JF. Trente-huit cas de lesions dysplasiques de l'artere mesenterique superieure. J Mal Vasc. 2005;30:150–61.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Aboumrad MH, Fine G, Horn Jr RJ. Intimal hyperplasia of small mesenteric arteries. Arch Pathol. 1963;75:196–200.

    CAS  PubMed  Google Scholar 

  9. 9.

    Palubinskas AJ, Ripley HR. Fibromuscular hyperplasia in extrarenal arteries. Radiology. 1964;82:451–5.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Ripley HR, Levin SM. Abdominal angina associated with fibromuscular hyperplasia of the celiac and superior mesenteric arteries. Angiology. 1966;17:297–310.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Wylie EJ, Binkley FM, Palubinskas AJ. Extrarenal fibromuscular hyperplasia. Am J Surg. 1966;112:149–55.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Patchefsky AS, Paplanus SH. Fibromuscular hyperplasia and dissecting aneurysm of the heparic artery. Arch Path. 1967;83:141–4.

    CAS  PubMed  Google Scholar 

  13. 13.

    Claiborne TS. Fibromuscular hyperplasia; report of a case with involvement of multiple arteries. Amer J Med. 1970;49:103–5.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Menanteau B, Segal S, Segal M. Hyperplasie fibro-musculaire des artères jéjunales. Ann Med Reims. 1971;8:215–8.

    Google Scholar 

  15. 15.

    André JM. Dysplasies fibreuses des artères. Aspects cliniques. Les dysplasies casculaires systématiques. 1973. p. 440–533.

    Google Scholar 

  16. 16.

    Stanley JC, Gewertz BL, Bove EL, Sottiurai V, Fry WJ. Arterial fibrodysplasia: histopathologic character and current etiologic concepts. Arch Surg. 1975;110:561–6.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Pinkerton JA, Wood WG, Fowler D. Fibrodysplasia with dissecting aneurysm of the hepatic artery. Surgery. 1976;79:721–3.

    PubMed  Google Scholar 

  18. 18.

    Lie JT, Kim HS. Fibromuscular dysplasia of the superior mesenteric artery and coexisting cerebral berry aneurysms. Angiology. 1977;28:256–60.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Stauber R, Gerstner L. Rupturiertes aneuerysma der a. colica media. Chirurg. 1979;50:331–3.

    CAS  PubMed  Google Scholar 

  20. 20.

    de Mendonca WC, Espat PA. Pheochromocytoma associated with arterial fibromuscular dysplasia. Am J Clin Pathol. 1981;75:749–54.

    Article  PubMed  Google Scholar 

  21. 21.

    Rybka SJ, Novick AC. Concomitant carotid, mesenteric and renal artery stenosis due to primary intimal fibroplasia. J Urol. 1983;129:798–800.

    CAS  PubMed  Google Scholar 

  22. 22.

    Foissy P, Fabre M, Lebaleur A, Buffet C, Frileux C, Étienne JP. Anévrysme du tronc de l'artere mésentérique supérieure et maladie polyanévrysmale de l'arcade bordante paracolique droite à type d'hyperplasie fibro-musculaire. Ann Med Interne. 1984;135:530–2.

    CAS  Google Scholar 

  23. 23.

    Quirke P, Campbell I, Talbot IC. Ischaemic proctitis and adventitial fibromuscular dysplasia of the superior rectal artery. Br J Surg. 1984;71:33–8.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Kyzer S, Bayer I, Turani H, Lewinsky U, Chaimoff C. Spontaneous rupture of the splenic artery as a presenting symptom of fibromuscular dysplasia of the artery. Acta Chir Iug. 1985;2:229–34.

    Google Scholar 

  25. 25.

    Hey A, Röckelein G. Arterial fibromuscular dysplasia as an unexpected cause of death in adults. Dtsch Med Wochenschr. 1987;112:1819–22.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Meacham PW, Brantley B. Familial fibromuscular dysplasia of the mesenteric arteries. South Med J. 1987;80:1311–6.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    den Butter G, van Bockel JH, Aarts JCNM. Arterial fibrodysplasia: rapid progression complicated by rupture of a visceral aneurysm into the gastrointestinal tract. J Vasc Surg. 1988;7:449–53.

    Article  Google Scholar 

  28. 28.

    Salmon PJM, Allan JS. An unusual case of fibromuscular dysplasia. J Cardiovasc Surg. 1988;29:756–7.

    CAS  Google Scholar 

  29. 29.

    Insall RL, Chamberlain J, Loose HWC. Fibromuscular dysplasia of visceral arteries. Eur J Vasc Surg. 1992;6:668–72.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 9-1995. A 60-year-old man with hypertrophic cardiomyopathy and ischemic colitis. N Engl J Med. 1995;332:804–10.

    Article  Google Scholar 

  31. 31.

    Stokes JB, Bonsib SM, McBride JW. Diffuse intimal fibromuscular dysplasia with multiorgan failure. Arch Intern Med. 1996;156:2611–4.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Yamaguchi R, Yamaguchi A, Isogai M, Hori A, Kin Y. Fibromuscular dysplasia of the visceral arteries. Am J Gastroenterol. 1996;91:1635–8.

    CAS  PubMed  Google Scholar 

  33. 33.

    Jones HJ, Staud R, Williams Jr RC. Rupture of a hepatic artery aneurysm and renal infarction: 2 complications of fibromuscular dysplasia that mimic vasculitis. J Rheumatol. 1998;25:2015–8.

    CAS  PubMed  Google Scholar 

  34. 34.

    Lee EK, Hecht ST, Lie JT. Multiple intracranial and systemic aneurysms associated with infantile-onset arterial fibromuscular dysplasia. Neurology. 1998;50:828–9.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Safioleas M, Kakisis J, Manti C. Coexistance of hypertrophic cardiomyopathy and fibromuscular dysplasia of the superior mesenteric artery. N Engl J Med. 2001;344:1333–4.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Horie TH, Seino Y, Miyauchi Y, Saitoh T, Takano T, Ohashi A, et al. Unusual petal-like fibromuscular dysplasia as a cause of acute abdomen and circulatory shock. Jpn Heart J. 2002;43:301–5.

    Article  PubMed  Google Scholar 

  37. 37.

    Kojima A, Shindo S, Kubota K, Iyori K, Ishimoto T, Kobayashi M, et al. Successful surgical management of a patient with multiple visceral artery aneurysms due to fibromuscular dysplasia. Cardiovasc Surg. 2002;10:157–60.

    Article  PubMed  Google Scholar 

  38. 38.

    Felton TW, Drewe E, Jivan S, Hall RI, Powell RJ. A rare case of shock. Ann Rheum Dis. 2003;62:705–6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Guill CK, Benavides DC, Rees C, Fenves AZ, Burton EC. Fatal mesenteric fibromuscular dysplasia. Arch Intern Med. 2004;164:1148–53.

    Article  PubMed  Google Scholar 

  40. 40.

    Mertens J, Daenens K, Fourneau I, Marakbi A, Nevelsteen A. Fibromuscular dysplasia of the superior mesenteric artery-case report and review of the literature. Acta Chir Belg. 2005;105:523–7.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Tsokas M, Nolting RO, Lockemann U. Sudden, unexpected death due to splenic artery aneurysm rupture. Am J Forensic Med Pathol. 2005;26:83–5.

    Article  Google Scholar 

  42. 42.

    Rodriguez Urrego PA, Flanagan M, Tsai WS, Rezac C, Barnard N. Massive gastrointestinal bleeding: an unusual case of asymptomatic extrarenal, visceral, fibromuscular dysplasia. World J Gastroenterol. 2007;13:5771–4.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Chaturvedi R, Vaideeswar P, Joshi A, Pandit S. Unusual mesenteric fibromuscular dysplasia-a rare cause for chronic intestinal ishaemia. J Clin Pathol. 2008;61:237.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Kinoshita H, Kubota A, Kasuda S, Nishiguchi M, Takahashi M, Ouchi H, et al. An autopsy case of rupture of an aneurysm of the splenic artery. Soud Lek. 2008;53:44–5.

    PubMed  Google Scholar 

  45. 45.

    Malago R, D'Onofrio M, Mucelli RP. Fibromuscular dysplasia: noninvasive evaluation of unusual case of renal and mesenteric involvement. Urology. 2008;71:755.e13–15.

    Article  Google Scholar 

  46. 46.

    Peynircioglu B, Cil BE. Standing waves of hepatic artery associated with renal and extrarenal fibromuscular dysplasia. Cardiovasc Intervent Radiol. 2008;31:S38–40.

    Article  PubMed  Google Scholar 

  47. 47.

    Shussman N, Edden Y, Mintz Y, Verstandig A, Rivkind AI. Hemobilia due to hepatic artery aneurysm as the presenting sign of fibro-muscular dysplasia. World J Gastroenterol. 2008;14:1797–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Azghari A, Elouannani M, Echarrab M, Elalami F, Amraoui M, Errougani A, et al. Hemobilia due to fibromuscular dysplasia of the hepatic artery. Gastroenterol Clin Biol. 2009;33:201–3. doi:10.1016/j.gcb.2008.12.010.

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Veraldi GF, Zecchinelli MP, Furlan F, Genco B, Minicozzi AM, Segattini C, et al. Mesenteric revascularisation in a young patient with antiphospholipid syndrome and fibromuscular dysplasia. Chir Ital. 2009;61(5–6):659–65.

    PubMed  Google Scholar 

  50. 50.

    Watada S, Obara H, Shimoda M, Matsubara K, Matsumoto K, Kitajima M. Multiple aneurysms of the splenic artery caused by fibromuscular dysplasia. Ann Vasc Surg. 2009;23:411.e5–7.

    Article  Google Scholar 

  51. 51.

    Kimura K, Ohtake H, Kato H, Yashiki N, Tomita S, Watanabe G. Multivisceral fibromuscular dysplasia: an unusual case of renal and superior mesenteric involvement. Ann Vasc Dis. 2010;3:152–6.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Senadhi V. A rare case of chronic mesenteric ischemia from fibromuscular dysplasia: a case report. J Med Case Rep. 2010;4:373.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Sugiura T, Imoto K, Uchida K, Yanagi H, Machida D, Okiyama M, et al. Fibromuscular dysplasia associated with simultaneous spontaneous dissection of four peripheral arteries in a 30-year-old man. Ann Vasc Surg. 2011;25:838.e9–11. doi:10.1016/j.avsg.2011.02.018.

    Article  Google Scholar 

  54. 54.

    da Gama AD, Ministro A, Cabral G, Pestana C, Oliveira P. Surgical management of a spontaneous dissection of the celiac axis caused by fibromuscular dysplasia. First clinical report. Rev Port Cardiotorac Vasc. 2012;19:211–5.

    Google Scholar 

  55. 55.

    Dolak W, Maresch J, Kainberger F, Wrba F, Müller C. Fibromuscular dysplasia mimicking Crohn’s disease over a period of 23 years. J Crohns Colitis. 2012;6:354–7.

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Patel NC, Palmer WC, Gill KRS, Wallace MB. A case of mesenteric ischemia secondary to fibromuscular dysplasia (FMD) with a positive outcome after intervention. J Interv Gastroenterol. 2012;2:4,199–201.

    Article  Google Scholar 

  57. 57.

    Cunha E, Sà D, Rosa A, Carmo GD, Costa T, Pestana C, et al. Abdominal angina due to fibromuscular dysplasia of the celiac axis. Surgical management. Rev Port Cardiotorac Vasc. 2013;20:41–4.

    Google Scholar 

  58. 58.

    Sekar N, Shankar R. Fibromuscular dysplasia with multiple visceral artery involvement. J Vasc Surg. 2013;57:1401.

    Article  PubMed  Google Scholar 

  59. 59.

    Unlü C, van den Heuvel DA, Leeuwis JW, de Vries JP. Ruptured aneurysm of the splenic artery associated with fibromuscular dysplasia. Ann Vasc Surg. 1799;2014(28):e15–8. doi:10.1016/j.avsg.2014.05.016.

    Google Scholar 

Download references

Author information

Affiliations

  1. Departments of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, QC, H1T 2M4, Canada

    Andrew Mitchell

  2. Department of Radiology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, QC, H1T 2M4, Canada

    Véronique Caty

  3. Department of Surgery, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, QC, H1T 2M4, Canada

    Yves Bendavid

Authors
  1. Andrew Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Véronique Caty
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yves Bendavid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew Mitchell.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AM drafted the manuscript and prepared the pathologic images. VC provided the radiologic images and associated discussion, and reviewed the manuscript. YB provided the clinical details and reviewed the manuscript. All authors read and approved the final manuscript.

Additional file

Additional file 1:

CARE Checklist (2013) of information to include when writing a case report.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mitchell, A., Caty, V. & Bendavid, Y. Massive mesenteric panniculitis due to fibromuscular dysplasia of the inferior mesenteric artery: a case report. BMC Gastroenterol 15, 71 (2015). https://doi.org/10.1186/s12876-015-0303-5

Download citation

Keywords

  • Mesentery
  • Panniculitis
  • Fibromuscular dysplasia
  • Visceral
  • Inferior mesenteric artery

BMC Gastroenterology

ISSN: 1471-230X

Contact us