Mesenteric panniculitis is a rare disease leading to recurrent acute abdominal pain, whose recognition is important to avoid any unwarranted aggressive surgery. A case of this condition is described. The patient, a 73-year-old man, attended our emergency room with acute abdominal pain, fever and prolonged partial thromboplastin time. He had a history of recurrent emergency department access and complained of the same rapidly reversible clinical picture. Findings at abdominal computed tomography and at diagnostic laparascopy (including histology of a biopsy) helped reach a correct diagnosis and treatment. In this brief report from literature analysis, we present diagnosis and treatment of mesenteric panniculitis from what is known so far. Finally, we briefly discuss some peculiar pathogenesis and hypothesis.