OVERVIEW
Caused by gastrointestinal infection, inflammatory bowel disease, and lymphoma
Mainly treated with pain relief and rehydration support
Generally good prognosis
Prevalent in children with gastrointestinal infections, inflammatory bowel disease, and lymphoma
Definition
Mesenteric lymphadenitis is a self-limiting disease of mesenteric lymph node infection, which may present as acute or chronic abdominal pain, and is most common in children and adolescents.
Mesenteric lymphadenitis occurs in the ileocecal region. In the early stages of the disease, there are scattered enlarged lymph nodes that are pink in color and soft in texture, and later become white and hard in texture. Occasionally, the lymph nodes become suppurative, often caused by respiratory or intestinal bacterial infections.
Morbidity
In a study that included 70 children with a clinical diagnosis of acute appendicitis, the diagnosis of mesenteric lymphadenitis was confirmed in 16% of the children by observing the course of the disease, ultrasonography, or surgical findings.
The increased prevalence of mesenteric lymphadenitis is associated with the increasing use of imaging to evaluate children with abdominal pain.
Etiology
Causes
Viral infections
The most common cause of mesenteric lymphadenitis.
Coxsackieviruses, enteroviruses, rotaviruses, and noroviruses can easily infect the gastrointestinal tract and cause mesenteric lymphadenitis in children.
Bacterial infections
Mesenteric lymphadenitis may occur after bacterial infections such as Salmonella, Yersinia, and Mycobacterium tuberculosis.
Inflammatory bowel disease
Inflammatory bowel disease is a chronic recurrent inflammatory disease of the intestinal tract caused by immunologic abnormalities of various etiologies, which is easily combined with various infections and mesenteric lymphadenitis.
Lymphoma
Children with lymphoma are immunocompromised and prone to bacterial and viral infections, causing mesenteric lymphadenitis.
Symptoms
Main Symptoms
Commonly found in children and adolescents over 3 years old, but can also occur in adults. It is common in winter and spring, and there is no gender difference in the onset of the disease. It often occurs during the course of upper respiratory tract infections or shortly after healing.
Abdominal pain
Abdominal pain is often paroxysmal, colicky or vague and lasts for about a few hours; the patient feels fine between episodes.
The pain can occur anywhere, but is most common around the umbilicus or in the right lower abdomen.
It may present as metastatic right lower abdominal pain.
Fever
Some children with mesenteric lymphadenitis develop fever, especially if combined with gastrointestinal bacterial or viral infections.
Diarrhea
Increased frequency and volume of stools, dilute and watery in nature, and dehydration in severe cases.
Nausea and vomiting
Children may also experience nausea and vomiting of stomach contents.
Consultation
Department of Medicine
Gastroenterology
Children with sudden onset of abdominal pain accompanied by fever, diarrhea, nausea, vomiting, or a recent history of upper respiratory tract infection are advised to seek prompt medical attention at the Division of Gastroenterology.
Pediatrics
Pediatric patients with the above symptoms may also be referred to the Department of Pediatrics.
Preparation
Preparing for the consultation: registration, preparation of documents, common problems
Tips
Record all the symptoms, time of day, and information from previous visits so that the doctor can treat you.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, etc.
Do you have sudden onset of abdominal pain?
Is there a fever? What is the highest temperature?
Is there nausea or vomiting? What is the vomit?
Is there an increase in the number of bowel movements? Is the stool normal in shape?
Any loss of appetite?
Do you sleep well?
How long have the above symptoms lasted?
List of medical history
Any recent upper respiratory infections, acute gastroenteritis?
Any history of inflammatory bowel disease?
Any history of lymphoma?
Checklist
Test results from the last 6 months to bring with you to your doctor’s appointment
Laboratory tests: blood tests.
Imaging tests: abdominal ultrasound.
Diagnosis
Diagnosis based on
Medical history
The following medical history may be present:
Recent upper respiratory tract infection, acute gastroenteritis.
History of inflammatory bowel disease.
History of lymphoma.
Clinical manifestations
Symptoms.
Sudden abdominal pain.
Fever.
Nausea, vomiting.
Thinning stools with a marked increase in stool frequency.
Physical signs
Abdominal pressure may be present, marked in the right lower abdomen; rarely rebound pain with abdominal muscle tension.
Cervical lymph nodes may be enlarged in some patients; in a few patients, enlarged lymph nodes may be found in the right lower abdomen.
Laboratory Tests
Blood tests
Find out whether the hemoglobin and platelet counts are normal.
The white blood cell count is often not elevated or is decreased, and the proportion of lymphocytes is increased.
Skin tuberculin test
To test liver and kidney function and to assess the general condition of the patient.
A positive skin tuberculin test is seen in people infected with Mycobacterium tuberculosis.
Imaging
Abdominal ultrasound: the abdominal lymph nodes are enlarged and have a diameter greater than 8 mm, whereas the appendix has no abnormal morphologic structure.
Calcified foci are found on X-ray abdominal plain films in some patients.
Differential diagnosis
The presentation of mesenteric lymphadenitis resembles that of acute appendicitis, and the differential points are as follows:
Similarities: Both mesenteric lymphadenitis and acute appendicitis can present with right lower abdominal pain.
Differences: Mesenteric lymphadenitis has milder symptoms and usually has no serious complications. Abdominal ultrasound reveals markedly enlarged abdominal lymph nodes and no appendiceal abnormalities. Acute appendicitis symptoms tend to be more severe and complications such as appendiceal perforation and abscess may occur. Abdominal ultrasound reveals a swollen appendix, fecaliths, and even periappendiceal oozing and abscess formation without abnormalities in the abdominal lymph nodes.
Treatment
Treatment aim: to relieve pain and prevent complications such as hydroelectrolyte disorders.
Treatment principle: Symptomatic supportive therapy is the mainstay, preventing and controlling complications.
Pain relief treatment
Children with symptoms of abdominal pain are relieved with antispasmodic and analgesic drugs, such as scopolamine and scopolamine.
When appendicitis, intussusception and other diseases cannot be excluded, antispasmodic painkillers should not be used blindly to avoid masking the symptoms and aggravating the condition.
Intravenous rehydration therapy
Children with increased nutritional needs and inability to eat can be treated with intravenous rehydration nutritional support.
Treatment of primary disease
Inflammatory bowel disease: therapeutic agents include aminosalicylic acid drugs, glucocorticoids, immunosuppressive agents, biological agents and microecological agents.
Lymphoma: mainly chemotherapy, which is selected according to the type of pathology.
Bacterial infections: cephalosporin antibiotics such as cefixime and cefaclor can be used.
Viral infections: do not need to use antiviral drugs, they can heal on their own.
Treatment of tuberculous mesenteric lymphadenitis is based on anti-tuberculosis drugs. The treatment regimen should be the same as for pulmonary tuberculosis and other extrapulmonary tuberculosis, i.e., a combination of 2 to 3 drugs with bactericidal or strong bacteriostatic effects and less toxic side effects should be used for 1 year.
Prognosis
Cure
Acute mesenteric lymphadenitis is generally a self-limiting disease.
Most cases of mesenteric lymphadenitis occur after a viral infection and often resolve on their own.
Abdominal pain in children with mesenteric lymphadenitis usually resolves within 1-4 weeks and lasts up to 10 weeks.
Children with mesenteric lymphadenitis who have prolonged lower right abdominal pain, poor appetite, weight loss, emaciation, or systemic symptoms such as fever and diarrhea need to be alerted to inflammatory bowel disease, intestinal tuberculosis, or malignant tumors.
Daily
Daily Management
Dietary management
Feed the child easy-to-digest, vitamin-rich, light food.
Children with diarrhea, nausea, vomiting and inability to eat can be given nutritional solution intravenously.
Life management
Keep the abdomen warm.
When the child’s condition is serious, rest is the mainstay.
After the symptoms of abdominal pain are relieved, gradually increase the amount of activity.
Nursing Rehabilitation
Parents carefully observe the child’s symptoms, food intake and sleep status, and take good care of the child.
Prevention
There is no effective prevention method for this disease, but the following measures can reduce the possibility of developing the disease.
Do not consume unclean food and drinks.
Avoid catching colds and flu, and actively treat upper respiratory tract infections.
Standardize the treatment of inflammatory bowel disease and lymphoma.