Mesenteric adenitis

Question 1

Define mesenteric adenitis

Answer 1

Inflammation of the mesenteric lymph nodes

Question 2

What is the aetiology and risk factors of mesenteric adenitis

Answer 2

Acute enlargement of the intra-abdominal lymph nodes as a results of infection in the upper respiratory tract, chest, or abdomen
The acutely enlarged lymph nodes cause pain

RF: Recent viral infection (URTI, LRTI, gastroenteritis), <15yo

Question 3

What are the symptoms of mesenteric adenitis

Answer 3

Recent viral infection (URTI, LRTI, gastroenteritis) ± lymphadenopathy
Abdominal pain: Central or RIF
Nausea ± diarrhoea
Reduced appetite
Current signs of infection in throat or chest
More likely to have high fever >39 and dysuria

Question 4

What are the differentials for mesenteric adenitis

Answer 4

Appendicitis
Gastroenteritis
Constipation
UTI
Somatisation

Question 5

What are the signs of mesenteric adenitis on examination

Answer 5

Obs: may show fever, otherwise normal
Abdo exam: normal, may be tender

Question 6

What investigations should be done for mesenteric adenitis

Answer 6

Diagnosis of exclusion

Bedside: urine MC&S, stool culture
Bloods: FBC (Raised WCC), CRP/ESR, U&Es, LFTs, blood gas
Other: US abdomen (exclude appendicits), laparotomy (not required unless unsure): large mesenteric nodes

Question 7

What is the management for mesenteric adenitis

Answer 7

Simple analgesia (symptoms usually resolve in a few days, maximum 2 weeks)
Safety net for increased pain, deterioration, etc.
Antibiotics if bacterial infection suspected
Laparoscopy to rule out other causes e.g. appendicitis – often diagnosed here (with normal appendix)

Question 8

What is the prognosis for mesenteric adenitis

Answer 8

Excellent - Symptoms improve within a few days, clearing up completely within 2 weeks