Primary and secondary mesenteric panniculitis: A descriptive cohort study with clinical and prognostic implications

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Background Mesenteric panniculitis is a chronic inflammation of the mesenteric adipose tissue, of uncertain clinical significance and with a possible link to malignancy. This study evaluated the clinical, radiological and prognostic characteristics of primary and secondary forms in an internal medicine cohort. Methods A retrospective cohort of adults with a radiological diagnosis of mesenteric panniculitis (2013–2024), analyzing demographic data, comorbidities, clinical presentation, radiological findings and clinical course. Cases were classified as primary or secondary when associated malignancy, autoimmune disease, or infection was present. Results One hundred eleven patients included (50% women; mean age 72.2 ± 13.1 years). 61.3% were primary and 38.7% secondary. 31.5% were asymptomatic; abdominal pain was the most common symptom. Mesenteric thickening was the predominant radiological finding. During follow-up, 85.6% remained clinically stable. Overall mortality was 8.1%, slightly higher in secondary forms, mainly those associated with neoplasms, with no significant differences compared to primary cases. Conclusions Mesenteric panniculitis mainly affected older adults, with a generally indolent course in primary forms, whilst secondary forms showed greater comorbidity.