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Mesenteric adenitis

Background knowledge 🧠

Definition

  • Mesenteric adenitis refers to inflammation of lymph nodes in the mesentery, often in response to infection.
  • Primarily affects the right lower quadrant, mimicking appendicitis.
  • Self-limiting in most cases, especially in children and young adults.

Epidemiology

  • Common in children and young adults under 16 years of age.
  • More prevalent in males than females.
  • Often occurs after viral or bacterial gastroenteritis.
  • May mimic other abdominal emergencies such as appendicitis.

Aetiology and pathophysiology

  • Usually secondary to viral or bacterial infections (e.g. Yersinia enterocolitica, Adenovirus).
  • Other causes include inflammatory bowel disease (IBD) and tuberculosis (rare).
  • Lymph nodes in the mesentery become inflamed in response to gut infection.
  • Resembles acute appendicitis due to overlapping clinical features.

Types

  • Primary: Occurs without an identifiable underlying cause, usually post-infectious.
  • Secondary: Occurs due to an underlying condition, such as IBD or tuberculosis.

Clinical Features 🌡️

Symptoms

  • Abdominal pain, typically in the right lower quadrant.
  • Pain may be intermittent or cramp-like in nature.
  • Fever, usually low-grade.
  • Nausea, vomiting, or diarrhoea may occur.
  • Symptoms often follow a viral or bacterial upper respiratory or gastrointestinal infection.

Signs

  • Tenderness in the right iliac fossa on palpation.
  • Rebound tenderness may be present but less severe than appendicitis.
  • Fever, typically mild.
  • Possible palpable lymph nodes in severe cases.
  • Normal bowel sounds.

Investigations 🧪

Tests

  • Blood tests: Full blood count (FBC) may show raised white blood cell count and C-reactive protein (CRP).
  • Urinalysis to exclude urinary tract infection or pyelonephritis.
  • Ultrasound: Confirms enlarged mesenteric lymph nodes and rules out appendicitis.
  • CT abdomen: Used if diagnosis remains uncertain, particularly in adults.

Management 🥼

Management

  • Supportive care: Rest, fluids, and pain relief (e.g. paracetamol, ibuprofen).
  • Antibiotics are not usually required unless bacterial infection is confirmed.
  • Consider hospital admission if severe symptoms, dehydration, or diagnostic uncertainty.

Complications

  • Rarely, abscess formation or sepsis if bacterial cause.
  • Intussusception is a potential, though uncommon, complication in children.

Prognosis

  • Typically self-limiting with resolution in 1-2 weeks.
  • Recurrence is rare but possible.
  • No long-term complications in most cases.

Key points

  • Mesenteric adenitis is a common mimicker of appendicitis in children.
  • Diagnosis is primarily clinical but can be supported by imaging.
  • Management is mainly supportive with good prognosis.

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