Mesenteric adenitis


MESENTERIC ADENITIS

Description:

Also called as mesenteric lymphadenitis.

An illness with abdominal pain and fever due to enlargement and inflammation of the mesenteric lymph nodes; often mistaken for appendicitis. Syn: mesenteric lymphadenitis.

Lymph glands (also called lymph nodes) occur throughout the body. They are normally pea sized. They are a major part of the immune system. During an infection, lymph glands swell and become painful while the immune system 'fights off' infecting germs. They go back to normal after the infection is over.

Your lymph nodes play a vital role in your body's ability to fight off illness. Approximately 600 nodes, scattered throughout your body, trap and destroy viruses, bacteria and other harmful organisms. In the process, the nodes closest to the infection can become sore and swollen — for instance, the lymph nodes in your neck may swell when you have a sore throat. Other nodes that commonly swell are located under your chin and in your armpits and groin. In a similar way, it is the lymph glands in the abdomen, next to the intestines, that swell during a bout of mesenteric adenitis.

Mesenteric lymphadenitis occurs mainly in children and teens and often mimics the signs and symptoms of appendicitis. Unlike appendicitis, however, mesenteric lymphadenitis is seldom serious and clears on its own in a few days or weeks.

Mesenteric lymphadenitis also can occur in healthy children who have no symptoms. In these cases, swollen lymph nodes are found on imaging tests for another problem. Mesenteric lymphadenitis that doesn't cause symptoms isn't a concern and rarely needs further evaluation.

Abdominal pain is common in children and teens, and it can be hard to know when it's a problem that needs medical attention. In general, if your child has sudden, severe abdominal pain or pain with fever, bloody diarrhea or vomiting, call your doctor right away.

Mesenteric lymphadenitis usually goes away on its own and rarely causes complications. But if swollen lymph nodes are caused by a serious bacterial infection that isn't treated, the bacteria could conceivably spread to your bloodstream, causing a potentially life-threatening infection (sepsis).

Symptoms:

The list of symptoms mentioned in various sources for Mesenteric Adenitis includes:

    Swollen abdominal lymph nodes.

  • Abdominal pain.

  • Nausea.

  • Vomiting.

  • Loss of appetite.

  • Headache.

  • Malaise.

  • Mild fever.

  • Viral infection - and various associated symptoms.

Causes and Risk factors:

Mesenteric adenitis is most frequently caused by viral pathogens, but other infectious agents have been implicated, including Yersinia enterocolitica, Helicobacter jejuni, Campylobacter jejuni, and Salmonella or Shigella species.An association with streptococcal infections of the upper respiratory tract, particularly the pharynx, has been reported. In younger children and infants, concurrent ileocolitis may be present; this finding suggests that the lymph node involvement may occur in reaction to a primary enteric pathogen.

Mesenteric lymphadenitis usually follow viral infection with the common cold, or with infection by Yersinia enterocolitica, Pseudo tuberculosis, Streptococcus viridansor Campylobacter jejuni.While Streptococcus viridans, Campylobacterand Pseudo tuberculosis infection are common world wide, infection by Yersinia enterocolitica is mostly found in the cold regions of the world, especially in Europe and Australia.

mesenteric adenitis

The bugs gain access to the wall of the intestine, and invade the lymph nodes on the covering of the intestines called the mesentery.The small intestine is frequently more involved, but the large intestines or colon may also be involved. The lymph nodes become enlarged due to inflammatory process induced by the micro-organisms. The inflammatory process, coupled with the stretch effect on the wall of the mesentery by the enlarged lymph node cause pain.Pus may form in severe cases and spread to cause disseminated infection.

Diagnosis:

Usually, it is diagnosed from your symptoms and a doctor's examination. If you (or your child) have typical symptoms and there are no signs of anything else causing the pain, then your doctor may think that mesenteric adenitis is likely. It is difficult to actually prove the diagnosis, because the glands are deep in the abdomen and cannot be seen or felt. So the diagnosis involves excluding other problems which could cause this type of pain, and then making a presumed diagnosis of mesenteric adenitis.

Sometimes it is difficult to make a diagnosis or to rule out other problems. For example, mesenteric adenitis can imitate other causes of abdominal pain, such as appendicitis or ectopic pregnancy (there are separate leaflets on these conditions).

If the diagnosis is not clear, your doctor may suggest:

    A period of observation ('wait and see'), with a review after a few hours to see if symptoms have changed.

  • A second opinion, for example, a referral to hospital for a surgeon's opinion.

  • Tests to look for other conditions.

  • There are no specific tests for mesenteric adenitis. However, some tests may help in diagnosing other conditions which could be causing the pain. For example, blood tests, urine test for infection, or scans (ultrasound or CT scan).

If there is any possibility that you could be pregnant, a pregnancy test is essential. This is because a serious condition called 'ectopic pregnancy', which can occur in early pregnancy, may cause symptoms similar to mesenteric adenitis.

In some cases, problems such as appendicitis or ectopic pregnancy cannot be ruled out even after tests. If so, you may need an operation to look inside the abdomen and check for any suspected problem. Sometimes this can be done as a `laparoscopy', where a thin fibre-optic telescope is used to look inside the abdomen.

If you have an operation or laparoscopy, then the inflamed glands may actually be seen. However, the purpose of the operation is not to look at the glands, but to ensure that other important problems are not missed.

Where strong doubt exists about the diagnosis, some laboratory and radiological investigations can be done. These include:

    Full blood Count: This may show evidence of infection, with elevated white blood cells. It can not differentiate between appendicitis, mesenteric lymphadenitis, or any other infection.

  • Yersinia Enterocolitica Serology: A positive serology will support the diagnosis of mesenteric adenitis.

  • Barium Enema: This is a very unlikely option in a child with abdominal pain. If done however, it may show indentation of the bowel walls from pressure by the enlarged mesenteric lymph nodes.

  • Ultrasound Scan: This may demonstrate hypoechoic nodules, which will be quite different from the surrounding tissues. Mesenteric thickening will also support a diagnosis of mesenteritis. This is often the first preferred investigation in children, since it is non -invasive, and there is no exposure to radiation (X-rays).

  • CT Scan: If done because the cause of abdominal pain remains unclear, in mesenteric adenitis, contrast CT will demonstrate enlarged mesenteric lymph nodes, plus a normal appendix.

  • Laparoscopy: If the diagnosis is still in doubt, a laparoscopy may lay it to rest. At laparoscopy, the lymph nodes surrounding the terminal ileum and colon may be found to be more in number and enlarged, with swelling of the mesentery, and a normal looking appendix.

Treatment:

Mesenteric lymphadenitis is often a benign illness, which usually resolves on it own without treatment.

Observing the child over night for a day may be needed in the hospital if parents are seriously worried.

Symptoms like fever may need administration of medications like paracetamol; vomiting if severe, may need oral rehydration or intravenous fluid administration.

Some times, mesenteric lymphadenitis infection may become severe, requiring the administration of antibiotics or even outright surgical operation to remove a section of diseased bowel plus the appendix.

Antibiotics are often started empirically in moderately to severely ill patients, using broad-spectrum antibiotics intended to cover the commonly associated pathogens. Antibiotic treatment should then be adjusted based on the sensitivity of the isolated pathogen. Treatment duration is variable based on the cause and severity of illness. For uncomplicated cases, antibiotic treatment is not necessary.

Home Remedies Include:

    Get plenty of rest.

  • Drink fluids.

  • Apply moist heat.

Medicine and medications:

    Metronidazole (Flagyl, Protostat).

  • Clindamycin (Cleocin).

  • Ampicillin (Omnipen, Polycillin).

  • Amoxicillin (Amoxil, Trimox).

  • Ciprofloxacin (Cipro).

  • Imipenem/cilastin (Primaxin).

  • Cefoxitin (Mefoxin).

  • Ticarcillin/clavulanate (Timentin).

  • Ampicillin/sulbactam (Unasyn).

Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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