In children, mesenteric adenitis is typically caused by viral or bacterial infections and can present with symptoms similar to appendicitis, such as abdominal pain (Periumbilical) , fever, and nausea.

  • Cause: Viral infections, bacterial infections, inflammatory bowel disease, or lymphoma
  • Yersinia pseudotuberculosis and Yersinia enterocolitica, these are two gram negative bacteria causing mesentric adenitis.
  • Types: Primary ( result from unidentifiable inflammatory process) and Secondary ( due to intra-abdominal inflammatory process with known source or etiology)

Note: Though, there is no evidence of association between junk food and mesentric lymphadenitis. In clinical setting, most child eating junk food (biscuit, noodle, etc) are found to have mesentric adenitis.

History and Examination

  • Recent history of Gastroenteritis or Upper respiratory tract infection
  • Eating Junk food
SymptomsSigns
Pain abdomen (Periumbilical mostly, or Right Lower Quadrant)
Nausea and vomiting
Loss of appetite
Loose stool, foul smelling, semi-digested
Fever

Abdominal tenderness (Periumbilical, RLQ)

Differential diagnosis (D/D) & Complication

D/D

  • Appendicitis (right lower quadrant pain, rebound tenderness, fever)
  • Gastroenteritis (diarrhea, vomiting, diffuse abdominal pain)
  • Acid Peptic Disease
  • Ovarian torsion or testicular torsion (pelvic or scrotal pain, vomiting, fever)
  • Functional dyspepsia

Complications:

  • Intussuception ( Excessive crying, vomiting)
  • Secondary bacterial infections,

Investigation

  • CBC, CRP (elevated)
  • URME (To rule of UTI)
  • USG Abdomen and Pelvis

USG Finding

Eenlarged, hypoechoic mesenteric lymph nodes and the absence of a thickened blind-ending tubular structure (inflamed appendix) is diagnostic of mesenteric adenitis.

Size of Mesentric Lymphnode: 10-12 mm is normal and does not require antibiotic.

Admission criteria

Admission may be necessary for severe pain, high fever, or suspicion of other serious conditions requiring further evaluation and management

Management

Medical

Rx:

  1. Syp or Tab Ranitidine PO BD x 7 days
  2. Syp Digestive enzyme ( Neopeptine) PO BD x 7 days
  3. Syp or Tab Ondem if vomiting
  4. Deworming if not done in past six months
  5. Syp Cyclopam if severe abdominal pain

Mesentric Lymphnode > 12mm and sign of infection (Fever, excessive nausea and vomiting, sever abdominal pain ), start antibiotic.

  • Syp or Tab Cefixime PO BD x 7 days
  • Syp or Tab Metronidazole PO TDS x 5 days

Advices

  • Drink Plenty of water.
  • Avoid Junk food, spicy food, and hot food.

Referral

  • Refer to a pediatric gastroenterologist or surgeon for further evaluation and management if the child is not responding to treatment, has persistent symptoms, or if another serious condition is suspected (e.g., appendicitis)

Follow up

  • Follow up within 2-4 weeks after resolution of the acute episode to ensure recovery and monitor for complications

References:

  1. Blumfield, E., & Misra, M. (2019). Mesenteric Lymphadenitis. In StatPearls [Internet]. StatPearls Publishing.