Mesenteric adenitis means swollen inflamed lymph glands in the tummy abdomen , which causes tummy pain. It is sometimes called mesenteric lymphadenitis. The mesentery is the part of the tummy where the glands are located. Adenitis means inflamed lymph glands. Mesenteric adenitis means swollen inflamed lymph glands in the tummy abdomen , which cause tummy pain.
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Right lower quadrant RLQ pain is a common initial presenting complaint with acute appendicitis as the most frequent cause. Mesenteric adenitis, also known as mesenteric lymphadenitis, is caused by inflamed mesenteric lymph nodes and is the second most common cause of acute RLQ abdominal pain.
Mesenteric adenitis can be classified as primary or secondary. Primary mesenteric adenitis is usually a self-limited disease, caused by both viruses and bacteria. The average age of patients presenting with mesenteric adenitis is approximately 25 years with an age range of years.
Classically, most cases were diagnosed after surgery for suspected appendicitis. If these patients have an acute onset, are relatively young and lack worrisome symptoms such as weight loss, then a presumptive diagnosis of mesenteric adenitis may be reasonable.
Observation in the hospital may be prudent and close outpatient follow-up will detect most misdiagnoses in a timely manner. In these cases, operative or non-operative biopsies may be needed to make a diagnosis.
Primary mesenteric adenitis classically presents with fever, RLQ abdominal pain, and leukocytosis mimicking acute appendicitis. A recent study in the pediatric population suggests that it is not clinically possibly to accurately distinguish between mesenteric adenitis and acute appendicitis.
Therefore, imaging is required to make a diagnosis. If the diagnosis remains uncertain, then laparoscopic appendectomy sometimes with mesenteric lymph node biopsy may be needed for confirmation.
Primary mesenteric adenitis has various causes with a large number of cases due to Yersina enterocolitica or Yersina pseudotuberculosis.
The typical patient is an adolescent or young adult with the acute onset of RLQ pain often with mild diarrhea. The pain may start in the upper abdomen or periumbilical region but will localize in the RLQ.
Diarrhea has been reported in over one-third and fever in over a half of confirmed cases of mesenteric adenitis caused by Y. There is a paucity of data on the illness caused by other pathogens. The tenderness to palpation may be less localized than in appendicitis.
Some patients may have signs or symptoms of infection elsewhere such as pharyngitis or lymphadenopathy. The differential diagnosis is that of acute abdominal pain, particularly in the RLQ quadrant. Several percent of patients undergoing appendectomy will be given a pathologic diagnosis of mesenteric adenitis.
Other causes of painful mesenteric lymphadenopathy include malignancy and, especially in immunocompromised hosts, less common infections such as Mycobacterium avium complex.
Almost any infectious or inflammatory disorder of the abdomen can do this as well including acute diverticulitis, cholecystitis, pancreatitis and perforated viscus. Right lower quadrant abdominal tenderness to palpation is the hallmark of the disease. Low-grade fever, guarding, rebound and rectal tenderness may also occur. This makes the disease difficult to distinguish from acute appendicitis.
Lymphadenopathy elsewhere on exam may help distinguish this condition. A complete blood count and, for women of childbearing age with a uterus, a pregnancy test, are essential laboratory studies.
A mild leukocytosis is common but not specific. Blood cultures should be obtained in those who are febrile and stool cultures in those with diarrhea. Those who are older, ill-appearing, have multiple comorbidities or atypical presentations may benefit from a chemistry profile, liver function tests and perhaps an amylase or lipase.
These tests are more useful in ruling out alternative diagnoses and determining the severity of illness than in confirming a diagnosis of mesenteric adenitis. If there is a high probability of appendicitis then surgical intervention may be reasonable without any imaging.
If there is a desire to avoid radiation then ultrasonography can sometimes identify enlarged mesenteric nodes as well as rule out adnexal pathology in women and, if identified, appendicitis. Computed tomography CT scans can easily see the mesenteric lymph nodes and are useful for ruling out a wide variety of diseases that may mimic mesenteric adenitis.
If the appendix is not well-visualized, acute appendicitis cannot be excluded. Early surgical consultation is often prudent. Additionally, imaging cannot determine the cause of the adenopathy unless other clear pathologies are found. Thus, even if acute appendicitis is ruled out, careful inpatient observation and outpatient follow-up is crucial to exclude secondary causes of mesenteric adenitis. The primary objective is to distinguish patients with a definite or probable surgical abdomen from those in whom observation, empiric treatment or CT-guided biopsy are reasonable options.
If this is not clear then early surgical consultation is needed. Although mesenteric adenitis is usually a mild, self-limited disease, initial management should be geared to stabilizing the patient and correcting electrolyte depletion and dehydration. In severe cases, antibiotics with activity against Yersinia that overlap with those that cover enteric pathogens, such as second- and third- generation cephalosporins, piperacillin, quinolones and imipenem may be used.
There is no evidence to support treatment of mild to moderate cases of Yersinia enterocolitis with associated mesenteric adenitis. In cases with severe systemic illness, bacteremia and immunocompromised patients, antibiotic treatment is indicated. Since many of these patients may go to surgery, any preoperative studies that might be indicated should be done and attention given to any active comorbidities that might affect the outcome.
Most patients should be held NPO nothing by mouth until a decision about surgery is made. If the diagnosis has been confirmed pathologically, these same signs should be followed at a lesser frequency.
Periodic CBC and chemistry profiles may be useful to follow the severity of illness and monitor fluid replacement. Mesenteric adenitis is usually a self-limited disease with no long-term management needs. However, if surgery is not performed, periodic outpatient follow-up will be needed to ensure a complete recovery is made and that the diagnosis of secondary mesenteric adenitis is eliminated.
Furthermore, primary mesenteric adenitis has occasionally had a relapsing-remitting course. If the patient continues to be ill, then re-imaging and possible biopsy of any persistently enlarged mesenteric lymph nodes may be indicated. Since lymphadenopathy may be present elsewhere in the many neoplastic and inflammatory conditions that initially mimic mesenteric adenitis, a good exam with attention to palpable lymph nodes could spare a patient the added risk of a CT-guided biopsy.
The major pitfall of management is to fail to consult a general surgeon early in the course of illness. Appendicitis may lead to enlarged mesenteric lymph nodes.
If the clinical impression suggests appendicitis, then early surgery is the safest course unless imaging clearly identifies a normal appendix. Even so, other surgical conditions such as a perforated cecal diverticulitis may also lead to painfully enlarged mesenteric lymph nodes. In cases where observation is undertaken, the patient must have regular follow-up as discussed above to ensure complete resolution of symptoms. Should this illness become subacute and no pathologic diagnosis was made in the hospital then a prompt search for an alternative diagnosis must be undertaken.
Comorbid conditions will largely affect the risk of surgery and post-operative management. However, immunocompromised patients are more likely to have opportunistic infections that mimic mesenteric adenitis.
These illnesses are more likely to present in a subacute manner and will not spontaneously resolve. If the patient does not appear to have a surgical abdomen, this population will often benefit from imaging guided biopsy.
As above, a good physical exam and a careful review of all imaging with the radiologist will determine if there are alternative locations for a biopsy that have a lower risk of complications. In those with known cancer, malignant adenopathy is common. In these cases, multiple other sites of adenopathy may be apparent. When the diagnosis has not been confirmed surgically, serial abdominal examinations may be needed.
Sign-out should ensure this occurs as well as information on the status of any surgical consultation. This reduces the possibility of a missed surgical abdomen. Though there is little data available for adults in the modern era, most patients with pathologically-confirmed mesenteric adenitis are young and healthy. Hospital stays for those who undergo surgery should be approximately days.
Those who undergo surgery are ready for discharge when their nutritional intake meets adequate daily caloric requirements, when they are passing flatus on a regular basis, and when they can ambulate safely.
Additionally, their pain should be controlled with oral medications. If the patient underwent surgery, then follow-up should be with their surgeon within one week of discharge. If the patient did not undergo surgery and they are significantly improved, then follow-up can be with their primary care doctor within weeks. If the patient did not undergo surgery but is being discharged without dramatic improvement or with ongoing diagnostic uncertainty, then follow-up should be with the surgeon within days and the primary care doctor within one week.
No additional tests are needed but the discharge instructions and discharge summary should both clearly state what tests if any i.
The patient and or family should be informed about who will provide them with any outstanding test results. No tests are needed prior to a follow-up appointment unless indicated by the specific clinical situation.
Full recovery is expected for those with a confirmed diagnosis as well as those who did not undergo surgery but have a high likelihood of mesenteric adenitis. For those discharged without a clear diagnosis who may have another cause for their painful mesenteric lymph nodes, the importance of early and regular follow-up should be emphasized.
Ian, Aird. British Medical Journal. This is a typical paper of the time period in which mesenteric adenitis became an accepted entity. The paper is descriptive and gives details of the history and exam that may allow the clinician to distinguish this entity from acute appendicitis.
American J of Roentgenology. Most of the modern articles on mesenteric adenitis are in the radiologic literature. These studies are useful as most of our patients with acute RLQ abdominal pain and fever will have imaging performed in the ER before the Hospitalist is asked to see them. These articles help us understand the benefits and pitfalls of these imaging studies and emphasize the need to talk to the radiologist directly, if there is any diagnostic uncertainty.
Toorenvliet, B, Vellekoop, A. European Journal of Pediatric Surgery. Modern article demonstrating the difficulty in clinically differentiating between acute appendicitis and mesenteric adenitis. All rights reserved.
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What Is Mesenteric Adenitis?
Yersiniosis is an acute or chronic, zoonotic disease caused by infection of Gram-negative rods Yersinia enterocolitica. It can be transmitted by the consumption of originally contaminated food products pork, unpasteurized milk or secondarily contaminated with animal or vegetable products. The clinical picture of infection may have a variable course is related to the age and physical condition of the patient, or pathogenic properties of microorganisms. Infection caused by Y. The aim of this study was to present a rare case of infection with Y. The natural reservoirs of these bacteria are wild and household animals pigs, cows, horses, sheep, goats, dogs, cats, and rabbits as well as birds turkeys, ducks, geese, pigeons, pheasants, and canaries. The source of the infection is mainly food and water contaminated by excrement of sick animals.
What's to know about esenteric adenitis?
Mesenteric adenitis is a condition that more often affects children and teenagers. It causes inflammation and swelling in the lymph nodes inside the abdomen. Lymph nodes are small, bean-shaped organs that contain white blood cells called lymphocytes. Lymph nodes play an important role in the immune system.