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digestive sclerolipomatosis

Thursday 6 December 2007

sclerolipomastoses; digestive fat-wrapping

Fat-wrapping is a characteristic feature of Crohn’s disease (CD).

Abnormalities of fat in the mesentery including adipose tissue hypertrophy and fat wrapping have been long recognized on surgical specimens as characteristic features of Crohn’s disease. However, the importance, origin, and significance of the mesenteric fat hypertrophy in this chronic inflammatory disease are unknown.

Localization

- mesenteric sclerolipomatosis

  • peri-ileal sclerolipomatosis

- mesocolic sclerolipomatosis

Etiology

- inflammatory digestive strictures in IBDs

  • Crohn disease (Crohn ileitis)
  • IPEX syndrome
  • indeterminate enteritis or indeterminate colitis

Physiopathology

- Leptin, a protein with a cytokine-like structure, is produced predominantly by adipocytes. It appears to play a key role in immune responses by increasing the secretion of Th1 and pro-inflammatory cytokines.

  • An increased leptin levels have been reported in animal models of intestinal inflammation.
  • Overexpression of leptin mRNA in mesenteric adipose tissue may contribute to (a) the inflammatory process, (b) enhancement of mesenteric TNF alpha expression in CD (as recently reported), and/or (c) the anorexia frequently reported during flares of IBD. (14732844)

- Peroxisome proliferator-activated receptor gamma (PPARgamma) is a crucial factor involved in the homeostasis of adipose tissue, a major source of biologically active mediators. Confined increased PPARgamma mesenteric concentrations could lead to the mesenteric fat hypertrophy, which could actively participate through the synthesis of TNF-alpha in the inflammatory response. (10381912)

See also

- mesenteric anomalies
- mesocolic anomalies
- sclerolipomatosis

References

- Overexpression of leptin mRNA in mesenteric adipose tissue in inflammatory bowel diseases. Barbier M, Vidal H, Desreumaux P, Dubuquoy L, Bourreille A, Colombel JF, Cherbut C, Galmiche JP. Gastroenterol Clin Biol. 2003 Nov;27(11):987-91. PMID: 14732844

- Inflammatory alterations in mesenteric adipose tissue in Crohn’s disease. Desreumaux P, Ernst O, Geboes K, Gambiez L, Berrebi D, Müller-Alouf H, Hafraoui S, Emilie D, Ectors N, Peuchmaur M, Cortot A, Capron M, Auwerx J, Colombel JF. Gastroenterology. 1999 Jul;117(1):73-81. PMID: 10381912

- Sheehan AL, Warren BF, Gear MW, Shepherd NA. Fat-wrapping in Crohn’s disease. Pathological basis and relevance to surgical practice. Br J Surg. 1992;79:955–958.

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