EMJ • June 2020 EMJ 108 Mesenteric Panniculitis in a Patient with Homozygous Factor V Leiden Gene Mutation: A Case and Literature to Review Abstract A 30-year-old Asian male with a significant history of deep vein thrombosis and family history positive for pulmonary embolism presented with complaints of fever, nonradiating epigastric pain, and a sense of abdominal fullness. After the initial workup, ultrasonography of the whole abdomen was carried out which showed thrombus formation in the portal vein. A CT scan of the abdomen was performed, which showed findings suggestive of mesenteric panniculitis. Keeping the significant family history and imaging findings in mind, the clotting and thrombin profiles were analysed and came back positive for the factor V Leiden gene (homozygous). A CT angiogram was performed to demonstrate extensive thrombosis throughout the abdominal vasculature with cavernous transformation. It is asserted that the chronic thrombosis on a background of factor V mutation led towards chronic inflammation of the mesentery. To the authors' knowledge it is the first reported case of mesenteric panniculitis in a patient with factor V homozygous gene mutation. INTRODUCTION Mesenteric panniculitis was first introduced by Jura in 1924, 1 who termed it retractile mesenteritis. Since then, it has also been called sclerosing mesenteritis, mesenteric fibrosis, mesenteric lipodystrophy, and mesenteric panniculitis. 2 It is a rare disease characterised by nonspecific chronic inflammation of the fatty tissue around the bowel mesentery. Its global prevalence is reported to be <1%. 2 The clinical features of mesenteric panniculitis are diverse, with abdominal pain being the most common symptom. A frequent clinical sign of mesenteric panniculitis is the presence of a palpable abdominal mass. Abdominal CT scan with intravenous contrast is the best imaging modality for the diagnosis of mesenteric panniculitis. There was no consensus established about the mainstay of treatment in a review of the literature. Authors: *Muhammad Sohaib Asghar, 1 Abubakar Tauseef, 1 Durre Naman, 1 Maryam Zafar, 1 Uzma Rasheed, 2 Narmin Khan, 1 Haris Alvi, 1 Nimra Shaikh 2 1. Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan 2. Liaquat National Hospital and Medical College, Karachi, Pakistan *Correspondence to sohaib_asghar123@yahoo.com Disclosure: The authors have declared no conflicts of interest. Acknowledgements: Ethical approval was received from the institutional review board and consent to participate has been taken from the patient’s guardian with informed verbal consent. Received: 30.01.20 Accepted: 21.04.20 Keywords: Inflammation, mesenteric panniculitis, mesentery, factor V Leiden, fibrosis, venous thrombosis. Citation: EMJ. 2020;5[2]:108-112.