Overview.
Retroperitoneal lymphadenitis is acute, chronic, or tuberculous retroperitoneal lymphadenitis due to bacterial, viral, or Mycobacterium tuberculosis infection. The disease is often difficult to diagnose before surgery. Increased sedimentation rate, tuberculous lesions elsewhere, abdominal masses and low-grade fever are common abnormalities, and X-rays, ultrasound and CT, and tuberculosis antibody or tuberculin tests are helpful in confirming the diagnosis. Final diagnosis depends on biopsy of the lesion site.
Etiology
It is generally believed that it may be related to the following factors:
1. Bacterial infection
Infections originating from the gastrointestinal tract or from other organs via the systemic blood circulation.
2. Viral infections
Mostly due to upper respiratory infections or mumps.
3. Mycobacterium tuberculosis infection
Retroperitoneal lymphadenitis tuberculous is more common, can be primary in the retroperitoneal lymph nodes or secondary to tuberculosis of the gastrointestinal tract, abdominal cavity and lungs.
Symptoms
1. Acute retroperitoneal lymphadenitis
High fever and chills are the main symptoms, accompanied by abdominal pain, abdominal distension, low back pain, nausea, vomiting, etc., and the body temperature can reach 39～40℃. On examination, abdominal pressure and rebound pain can be seen, but muscle tension is not obvious. In severe cases, there may be signs of intestinal paralysis, low back pain, white blood cell count may be elevated.
2. Chronic or tuberculous retroperitoneal lymphadenitis
Mycobacterium tuberculosis may invade the retroperitoneal lymph nodes, either as one of the localized components of the primary syndrome or as a result of widespread dissemination of the tubercle bacilli. The involved lymph nodes may be treated asymptomatically and eventually calcify. Some lymph nodes are enlarged and undergo caseous necrosis or even abscess formation. The disease has an insidious onset with vague or even absent symptoms. The main symptoms are persistent or paroxysmal vague pain or distension in the abdomen, accompanied by low-grade fever, nausea, vomiting, abdominal distension, loss of appetite, etc. Abdominal pain in this disease can be intermittent episodes, which are often ineffective after treatment with anti-infective or anti-tuberculosis and antispasmodic therapy. Abdominal examination may reveal a palpable mass or limited fullness with deep tenderness, no abdominal muscle tension, and active bowel sounds.
Examination
X-ray, B-mode ultrasound and CT, tuberculosis antibody or tuberculin test.
Diagnosis
Diagnosis can be made on the basis of the above symptoms, signs and laboratory tests.
Differential diagnosis
It should be differentiated from lymphoma, pancreatic cancer, retroperitoneal or mesenteric tumors, nodular disease, appendicitis, adnexitis, malignant tumors, benign lymphoid hyperplasia and infectious mononucleosis.
Treatment
Antibacterial drugs or herbal medicine are mainly given to address the nature of the infection. For tuberculosis should be given regular anti-tuberculosis treatment, but the course of treatment needs to be 1 to 2 years, for larger abscesses need to do drainage. For the more limited mass or the neighboring organs are compressed by non-surgical treatment is ineffective, surgical resection can be used.
Prevention
Prevention of tuberculosis is the root cause of prevention of this disease.