Acute mesenteric lymphadenitis is one of the common causes of abdominal pain in pediatric patients and is clinically confused with acute appendicitis, mostly seen in children under 7 years of age, and is mostly a viral infection. It occurs in winter and spring and is often complicated by acute upper respiratory tract infections or secondary to inflammatory bowel disease. Typical symptoms are fever, abdominal pain, vomiting, and sometimes diarrhea or constipation. Acute mesenteric lymphadenitis is also known as acute nonspecific mesenteric lymphadenitis.
Symptoms and signs
The typical presentation is a sore throat and malaise followed by fever, abdominal pain, vomiting, and sometimes diarrhea or constipation after an upper respiratory tract infection. About 20% of children have enlarged lymph nodes in the neck. The first symptoms of the disease are
Abdominal pain is the earliest symptom of the disease and can be anywhere, but because the lesion mainly invades a group of lymph nodes in the terminal ileum, it is common in the right lower abdomen, and the nature of abdominal pain is not fixed, but can be vague or spasmodic, and the child feels better between pains. The most sensitive site of tenderness may be different on each physical examination, and the site of pressure pain is near the midline or high, unlike in acute appendicitis, and is less severe than in acute appendicitis, with less rebound pain and abdominal muscle tension. Occasionally, a small nodular mass with pressure pain may be found in the right lower abdomen as an enlarged mesenteric lymph node. Some patients may have intestinal obstruction, which should be monitored.
Acute mesenteric lymphadenitis should be considered in younger children with clinically similar symptoms to appendicitis, but in a milder form without abdominal muscle tension, and the abdominal pain usually improves significantly after fasting, intravenous fluids, and antibiotics, without surgical treatment. However, sometimes it is difficult to differentiate from appendicitis, and surgical investigation is recommended for those whose symptoms do not improve with treatment and observation.
Treatment with medication
If the diagnosis is confirmed, conservative treatment is available.
The abdominal pain can be improved and gradually recovered without surgical treatment. However, if the symptoms do not improve after the above treatment, or if it is difficult to differentiate from acute appendicitis, surgical investigation is recommended. Salmonella, if acute mesenteric lymphadenitis is one of the common causes of abdominal pain in children, it is easily confused with acute appendicitis clinically, mostly in children under 7 years old, and is mostly a viral infection. It occurs in winter and spring and is often complicated by acute upper respiratory tract infections or secondary to inflammatory bowel disease. Typical symptoms are fever, abdominal pain, vomiting, and sometimes diarrhea or constipation. Acute mesenteric lymphadenitis, also known as acute nonspecific mesenteric lymphadenitis, was first described by Brenneman (1921) and is usually treated effectively with medication.
Symptoms and signs Typically, sore throat and malaise followed by fever, abdominal pain, vomiting, and sometimes diarrhea or constipation are seen after upper respiratory tract infection. About 20% of children have enlarged lymph nodes in the neck.
Abdominal pain is the earliest symptom of the disease and can be anywhere, but because the lesion mainly invades a group of lymph nodes in the terminal ileum, it is common in the right lower abdomen, and the abdominal pain is variable in nature and can be vague or crampy. The most sensitive site of tenderness may be different on each physical examination, and the site of pressure pain is near the midline or high, unlike in acute appendicitis, and is less severe than in acute appendicitis, with less rebound pain and abdominal muscle tension. Occasionally, a small nodular mass with pressure pain may be found in the right lower abdomen as an enlarged mesenteric lymph node. Some patients may have intestinal obstruction, which should be monitored.
Acute mesenteric lymphadenitis should be considered in younger children with clinically similar symptoms to appendicitis, but in a milder form without abdominal muscle tension, and the abdominal pain usually improves significantly after fasting, intravenous fluids, and antibiotics, without surgical treatment. However, sometimes it is difficult to distinguish from appendicitis, and surgical investigation is appropriate for those whose symptoms do not improve with treatment and observation.
Medication: If the diagnosis is confirmed, conservative treatment is available. Generally, abdominal pain can be significantly improved and gradually recovered after fasting, intravenous fluids and antibiotics, and surgery is not necessary. However, if the symptoms do not improve after the above treatment, or if it is difficult to differentiate from acute appendicitis, surgical investigation is recommended. In cases caused by Salmonella, if an abscess is formed or symptoms of peritonitis appear, surgical drainage is performed. Some children may be complicated by intussusception and should be observed.
Salmonella infection causing gastrointestinal disease is most common in gastroenteritis, and acute mesenteric lymphadenitis has also been reported. Mesenteric lymphadenitis caused by Salmonella infection is different from viral lymphadenitis and is more common in children or adolescents. Bacterially-infected lymph nodes mostly show acute inflammatory reaction, hemorrhage and necrosis in the lymph nodes, and Salmonella can be isolated from the lymph nodes. If an abscess is formed or peritonitis symptoms appear, surgical drainage is performed.
Dietary care: Diet should be light, pay attention to hygiene, and match meals reasonably.
Preventive care: mesenteric lymphadenitis is mostly a viral infection, often complicating the course of acute upper respiratory tract infection or secondary to intestinal inflammation. Therefore, attention is usually paid to the prevention of colds and fevers and to the regularity of diet.
Pathogenesis: Since the lymphatic drainage of the distal ileum is very rich, there are many lymph nodes in the ileum and large intestine area. After upper respiratory tract infection or intestinal infection, viruses, bacteria and their toxins reach the lymph nodes in this area along the blood circulation, causing mesenteric lymphadenitis. Viral infections manifest as mesenteric lymph node hyperplasia, edema, and congestion, but cultures are negative. Mesenteric lymphadenitis caused by Salmonella infection differs from viral lymphadenitis in that the lymph nodes infiltrated by bacteria mostly show acute inflammatory reaction, hemorrhage and necrosis in the lymph nodes, and Salmonella can be isolated from the lymph nodes.
Diagnosis of disease: The diagnosis of acute mesenteric lymphadenitis requires the exclusion of hyperperistalsis, intestinal ascariasis and other causes of abdominal pain.
1. Acute appendicitis The symptoms are similar, but acute mesenteric lymphadenitis is milder and starts more slowly. Children with typical appendicitis have metastatic right lower abdominal pain, fixed pressure and rebound pain in the right lower abdomen, and abdominal muscle tension. The total leukocyte count and neutrophils are elevated.
2. Tuberculous mesenteric lymphadenitis has a slow onset. In addition to abdominal pain and fever, there are often symptoms of tuberculosis poisoning such as night sweats, emaciation, loss of appetite, and other sites of tuberculosis infection, and tuberculin tests or tuberculosis antibodies can help to identify them.
3. Infectious mononucleosis may also present with enlarged mesenteric lymph nodes, but is often accompanied by enlarged cervical lymph nodes and splenomegaly, and examination of anomalous lymphocytes, cold agglutinin, and EBV potency is helpful for diagnosis.
Examination methods
Laboratory tests: Leukocytes may be normal or mildly elevated after the onset of the disease.
Pathological manifestations include lymph node hyperplasia, edema, and congestion, but cultures are often negative. Stool and urine routine are normal.
Other auxiliary examinations: ultrasonography shows thickening of the abdominal mesentery and multiple enlarged mesenteric lymph nodes of different sizes, mostly located in the right lower abdomen, which are smooth and intact in shape, with clear demarcation of the cortex and medulla, hypoechoic, with uniform echogenicity within them, and a small amount of liquid dark areas visible in the abdominal cavity. And can identify acute appendicitis, pelvic inflammatory disease, ovarian disease.
Complications: itself is often a complication of upper respiratory tract infection, because the children mostly have vomiting, eating less, so water, electrolyte disorders are common; some patients may be complicated by intestinal overlap, complicating intestinal obstruction.
Prognosis: Very good, with most recovering without any specific treatment. Death is rare and may occur only in the presence of secondary specific bacterial infections (septicemia caused by Streptococcus haemolyticus, lymph node rupture and post-rupture abscesses and peritonitis).
Pathogenesis: Pediatric mesenteric lymph nodes are abundantly distributed along the mesenteric arteries and their arterial arches. Small intestinal contents often stay at the end of the ileum due to the action of the ileocecal valve, so intestinal bacteria and viral products are easily absorbed into the ileocecal lymph nodes there, causing mesenteric lymphadenitis. If an abscess is formed or symptoms of peritonitis appear, surgical drainage is performed. Some children may be complicated by intussusception and should be monitored.
Salmonella infection causing gastrointestinal disease is most common in gastroenteritis, and acute mesenteric lymphadenitis has also been reported. Mesenteric lymphadenitis caused by Salmonella infection is different from viral lymphadenitis and is more common in children or adolescents. Bacterially-infected lymph nodes mostly show acute inflammatory reaction, hemorrhage and necrosis in the lymph nodes, and Salmonella can be isolated from the lymph nodes. Conservative treatment is indicated, and if an abscess forms or symptoms of peritonitis appear, surgical drainage is indicated.