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Subject: Mesenteric Adenitis
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Characterized by benign inflammation of the mesenteric lymph nodes; can be acute or chronic
May clinically mimic acute appendicitis
Commonly misdiagnosed, making definitive incidence unknown
Most common cause of appendicitis-like pain in children 1
More common in children ≪15 years old than in adults
Adenitis secondary to Yersinia infection is more prevalent in boys than girls.
Primary: underlying inflammatory process not present; presumed due to acute infectious gastroenteritis (specifically, terminal ileitis)
Secondary: underlying inflammatory process present (see “Commonly Associated Conditions”)
In infectious etiologies, pathogens are ingested, translocate through the intestinal epithelium via Peyer patches, and gain access to mesenteric lymph nodes. An inflammatory reaction within mesenteric lymph nodes causes symptoms and clinical disease. Infectious agents include:
Typically preceded by URI or pharyngitis
History of ingesting undercooked pork particularly in areas where Yersinia is endemic (parts of Europe).
Other systemic inflammatory/autoimmune disease
Nausea and vomiting (may precede abdominal pain)
Abdominal pain: periumbilical, RLQ
Fever, malaise, fatigue, anorexia
Recent history of upper respiratory tract infection
Fever; can have toxic appearance
Abdominal tenderness; (with or without rebound and often in the RLQ)
Appendicitis, intussusception, intestinal duplication, regional enteritis (Crohn disease), Meckel diverticulitis, ulcerative colitis
Epiploic appendagitis, mesenteric ischemia
Salpingitis, PID, ectopic pregnancy
Neoplasm (e.g., lymphoma)
CBC: leukocytosis with left shift
Basic metabolic panel may show electrolyte disturbances and azotemia if dehydrated and/or alkalotic from recalcitrant vomiting.
β-HCG in women of childbearing potential
Stool cultures if diarrhea
Serologies if specific infectious agent suspected
Blood cultures if septic
CT scan: enlarged mesenteric lymph nodes (larger in size, number, and distribution than appendicitis)
Ultrasound: less sensitive; used for exclusion of other potential diagnoses
Lymph nodes are enlarged and soft.
Adjoining mesentery may be edematous.
Microscopically, lymph nodes display nonspecific hyperplasia. If a suppurative infection is present, lymph nodes may contain necrotic material with pus formation.
Supportive and symptomatic treatment for uncomplicated cases
IV fluid resuscitation if hypovolemic
Correct underlying electrolyte aberrations.
Broad-spectrum antibiotic therapy for moderately to severely ill patients if diagnosis is unclear pending workup and/or surgical evaluation
Treatment duration varies based on cause and severity of illness. For uncomplicated cases, antibiotic treatment is not necessary.
Admit patients with complications and/or hemodynamic instability.
Volume resuscitation and correction of underlying electrolyte abnormalities
IV fluids may be indicated for patients who cannot tolerate PO intake due to nausea or vomiting.
Aggressive fluid hydration is indicated if there is any evidence of sepsis.
Discharge criteria: hemodynamic stability, able to tolerate PO diet, able to follow up in the outpatient setting
Generally self-limiting and benign condition
Increased morbidity/mortality for patients presenting with sepsis
Increased GI losses leading to hypovolemia and electrolyte imbalance
Abscess formation, peritonitis, sepsis
Latent extraintestinal manifestations, including arthralgias, truncal and extremity rashes, and erythema nodosum with Y. enterocolitica infection
Postinfectious chronic complications of Yersinia infection including reactive arthritis, conjunctivitis, urethritis; postinfectious irritable bowel syndrome
267548000 Nonspecific mesenteric adenitis
49631001 Acute mesenteric adenitis
191377002 Chronic mesenteric lymphadenitis (disorder)
44897000 Mesenteric lymphadenitis
Mesenteric adenitis is an inflammatory process that mimics appendicitis. Diagnosis requires imaging to distinguish from acute appendicitis.
The condition is more common in children, often following a URI.
The treatment is generally supportive care.