Diagnosis

Mesenteric adenitis

Etiology

Cause [v9e][84t]

• Primary mesenteric lymphadenitis:

  • Enlarged mesenteric lymph nodes in the absence of other abnormalities. Usually a self-limited inflammatory process.

• Secondary mesenteric lymphadenitis:

  • Acute Mesenteric Lymphadenopathy:

    • Viral

    • Bacterial gastroenteritis: salmonella, E coli, and streptococci, Yersinia

    • Diverticulitis

    • Appendicitis

    • Infectious mononucleosis (EBV)

  • Chronic Mesenteric Lymphadenopathy:

    • Inflammatory bowel disease: Crohn's disease and ulcerative colitis

    • Chronic inflammatory diseases: SLE, sarcoidosis

    • Malignancy

    • HIV infection

    • Tuberculosis

Pathophysiology [v9e]

1. The infectious agent is normally ingested orally (or rarely hematogenous spread)

2. Gastrointestinal inflammation

3. Regional infection through lymphatic pathways to mesenteric lymph nodes

4. Reactive mesenteric adenitis/lymphadenopathy near the terminal ileum

Epidemiology

Incidence per 100.000 [km3][8nq][7cb][8gb]

Approach

• Blood test

• Urine stix

• Abdominal x-ray

• Ultrasound abdomen

• CT abdomen

• Nuclear scintigraphy

• Laparoscopy

Treatment

1. Exclude potentially life-threatening diagnoses [v9e]

2. Self-limiting disease and requires supportive care:

   • IV hydration

   • Pain control with NSAIDs

3. Consider appendectomy if recurrent lymphadenitis

Differential diagnoses

Acute intermittent porphyria, Acute mesenteric ischemia, Acute pancreatitis, Appendicitis, Benign neoplasm of the small intestine, Breast cancer, Cholecystitis, Chronic mesenteric ischemia, Colorectal cancer, Crohn disease, Diverticulitis, Epididymitis, Familial mediterranean fever, Gastrointestinal lymphoma, HIV, Intussusception, Lung cancer, Lymphoma, Meckels diverticulum, Mononucleosis, Ovarian torsion, Pancreatic cancer, Pelvic inflammatory disease, Pyelonephritis, Rheumatoid arthritis, Ruptured ectopic pregnancy, Ruptured ovarian cyst, Sickle cell disease, Small bowel cancer, Systemic lupus erythematosus, Systemic sclerosis, Testicular torsion, Tuberculosis, Ulcerative colitis, Urinary tract infection, Whipple's disease