Mesenteric Adenitis

What is Mesenteric Adenitis?

Also known as mesenteric lymphadenitis, mesenteric adenitis refers to medical condition in which the lymph nodes that lie in the abdomen mesentery become inflamed. Abdomen mesentery refers to the tissue that connects your intestines in to the abdominal wall’s internal lining.

This inflammation of the lymph nodes causes tenderness, abdominal pains, fever and other severe symptoms. The main purpose of the lymph nodes in the body is helping the body fight attack and infections by diseases. This condition mainly develops in teens and kids but it can develop in adults also. The mesenteric adenitis symptoms are often very similar to those of appendicitis.

The condition may be chronic mesenteric adenitis or acute mesenteric adenitis depending on the factor causing it.

Mesenteric Adenitis and Appendix

To avoid unnecessary surgery for the treatment of non-existent appendix problems, the patients that present appendicitis symptoms should undergo further screening to confirm or out rule this condition.

In the past, the diagnosis for mesenteric adenitis used to be performed after laparotomy test for appendicitis tested negative. Sonogram of the healthy persons shows that they the lymph nodes are oval and thy have fatty hilum that has short-axis diameter not more than 5 mm.

In the patients suffering from mesenteric adenitis, the appendix is in most cases very normal but cecum and the ileum may be thickened while the lymph nodes are inflamed.

What causes Mesenteric Adenitis?

Tests on the blood samples and the lymph nodes of the persons suffering from mesenteric adenitis have showed that for mesenteric adenitis to occur, microorganisms invade the lymph nodes through the intestinal lymphatics.

These microorganisms multiply; depending on the causal organism, there may be varying degrees of inflammation. There may be suppuration in some rare cases. After infection, the lymph nodes are in most cases soft and enlarged.

The adjacent mesentery may be swollen and filled with fluid (edematous) and it may be with or without any exudates. If there is an underlying medical condition like appendicitis, there may be some inflammation.

The organisms that may cause the mesenteric adenitis include

• beta-hemolytic streptococcus
• Escherichia coli,
• Staphylococcus species,
• Giardia lamblia,
• Mycobacterium tuberculosis,
• non-salmonella typhoid,
• the Yersinia species (these are the leading causes of the condition in the Eastern Europe countries like Belgium)
• Viruses e.g. the rubeola virus, coxsackie virus A and coxsackie virus B. Some cases of mesenteric adenitis have also been linked to the adenovirus serotypes I, II, III, V and VII. Other viruses like the HIV virus and EBV (Epstein-Barr virus) can also cause it.

Other Mesenteric Adenitis causes

The mesenteric adenitis has also developed in some people suffering from the cat scratch disease.

Mesenteric adenitis in children causes upper respiratory tract infection has led to the development of theory and belief that pathogen –laden sputum that was swallowed by the patient may be the initial source of the infection.

This condition may also develop when a healthy person comes in to contact with the fecal matter of an infected person.

The condition may also develop from the consumption of contaminated milk, meat and water.

What is the prevalence of Mesenteric Adenitis?

In the United States, there is no concrete data of mesenteric adenitis because the condition can very easily be mistaken or missed for other conditions that present similar symptoms. Doctors however believe that the condition is common among the children and teens.

Medical data tends to show that about 20% of the patients that undergo treatment for appendix problems are diagnosed with mesenteric adenitis.

Internationally, the mesenteric adenitis is also very common especially at the temperate countries in North America, Australia and Europe.

The highest incidence of mesenteric adenitis in the world is in the Eastern Europe region.

The condition affects both genders almost equally but it is slightly higher in young boys than in the young girls.

Mesenteric Adenitis Prognosis

Generally speaking, mesenteric adenitis is not fatal and the patients should expect full recovery from the condition. The patients that have underlying conditions like sepsis may however be under greater risk. Sepsis refers to the condition in which the body (including body organs and tissues) becomes inflamed because of response to an underlying infection.

Research shows that the kids and teens that develop mesenteric adenitis at their childhood are at lower risk of developing ulcerative colitis at their adulthood age. This research was conducted by Frisch and other scientists who made a review of Danish and Cohort studies that involved 709, 353 patients that had been treated of mesenteric adenitis. These patients were followed up to assess their risk of developing ulcerative colitis and these scientists came to the already stated conclusion.

Who is at the risk of developing Mesenteric Adenitis?

Depending on the causal factors and the way it develops, anyone can develop mesenteric adenitis but the condition is very rare in the adults. It is very common in the kids and children below the age of 15 years.

What are the symptoms of Mesenteric Adenitis?

Most patients that suffer from mesenteric adenitis may not be able to teal exactly how the initial feelings were. Note that this condition mainly affects teens and kids so they will generally say that thy feel unwell. Like most other conditions, the symptoms vary from one patient to another.

The following are however the symptoms to watch out for

• Abdominal pains – especially at the right lower quadrant but it may in some instances be diffuse
• Anorexia
• Diarrhea
• Nausea
• Vomiting
• Malaise
• Fever of between 38 and 38.5⁰C
• Upper respiratory infection
• Rhinorrhea
• Tenderness of the rectum
• Toxic appearance
• Voluntary guarding

How is Mesenteric Adenitis diagnosed?

Doctors use a medical diagnostic procedure known as Ultrasonography to confirm or out rule this condition in patient. This has even been recommended by the American College of Radiology as the first diagnostic procedure in the patients that are aged 14 years and younger and which present with complaints and symptoms of leukocytosis, fever and appendicitis symptoms.

The ACR recommendations are to the effect that abdominal CT (Computer Tomography) that has intravenous contrast can be very helpful in those kids that have ultrasound studies that are negative. It has recommended that this diagnostic technique is the most suitable for the adults and adolescents that have this presentation.

CT is highly relied on in the evaluation of appendicitis in men and in all the other patients in whom the appendix may not be easily visible because of the natural body structure. Even though these findings are not very specific, these abdominal radiographs rarely reveal the exact finings but they give way to other diagnostic procedures like appendicolitis.

In some mesenteric adenitis treatment centers, CT is carried out for appendicitis evaluation without oral and/or the intravenous enhancement of contrast. This approach has the effect of reducing the sensitivity of CT for the thickening of the bowel wall and the mesenteric adenopathy especially in the small kids that have a lot of intraperitoneal fats.

In some patients, the normal appendix may not be clearly examined through sonography because it (the appendix) is hidden. When enlargement of the lymph node is detected through this examination, it is difficult to exclude appendicitis as one of the possible causes of reactive adenopathy.

In any modality of imaging, the finding of the enlargement of the lymph nodes as a finding that is isolated is not very specific. This is so because the inflammation (of lymph nodes) can be caused bay various factors. In some rare cases, some children without clinical symptoms of any disease may have lymph nodes are slightly larger than the normal size.

In the wake of the recent concern about the effects of radiation on kids, the condition of each individual patient should be taken as an independent case. In general sonography is generally preferred as the most initial diagnosis instead of the computer Tomography.

The radiography findings about Mesenteric Adenitis

In the patients suffering from mesenteric adenitis, the radiography findings on supine and upright abdomen are in most cases very normal. The findings that are non-specific include regional ileus or thickening of the bowel wall at the abdominal right lower quadram.

The plain findings of radiography may not indicate any particular diagnosis in this condition but they in some cases confirm it when they are taken as alternative diagnosis. There may however be indication of the cross-sectional imaging notwithstanding the plain findings of radiography.

The nuclear imaging findings about Mesenteric Adenitis

Nuclear imaging is rarely used in the diagnosis of mesenteric adenitis because it is not very useful. In only one case, nuclear imaging showed localization of white cells in the right lower quadrant, cervical lymph nodes and nasopharynx during the imaging.

The white blood cells of the 4 year old boy that was examined in this case were balled with indium-111. The boy had pharyngitis, fever and abdominal pains that can characterize mesenteric adenitis and other conditions as well.

The Computer Tomography (CT) findings about Mesenteric Adenitis

In the cases of mesenteric adenitis that have been diagnosed by the use of Computer Tomography (CT), the findings in normal appendix setting show mesenteric lymph nodes that are enlarged and they may be associated or not associated with thickening of the ileocal or ileal wall.

The lymph nodes in this examination are in most cases are numerous, larger and widely distributed in the case of mesenteric adenitis than in the case of appendicitis. The thickening of ileum is usually diagnosed when the ileum wall is more than 3mm thick or more than 5cm of the patient’s bowel.

Further imaging may not be indicated even though there may be no definitive inference of mesenteric adenitis especially if the laparotomy for appendicitis evaluation was negative.

In this diagnostic setting, it is very easy to mistake nonopacified bowel with lymph nodes that are enlarged especially in the small kids and thin adults. It is also difficult to determine the thickness of bowel wall from CT images for diagnosis of mesenteric adenitis.

The ultrasonography findings about Mesenteric Adenitis

The ultrasonography for diagnosing mesenteric adenitis shows clustered lymph nodes that are in most cases five or more. In most of the patients, the nodes are tender. The nodes are hypoechoic and rounded than those of healthy person.

The nodes that are abnormal have diameter with short axis that is in most cases 5mm but it may be more than 1cm in some cases. These nodes are numerous and larger in the case of mesenteric adenitis than in the case of appendicitis.

Treatment for Mesenteric Adenitis

In most cases, mesenteric adenitis clears on its own without the need of mesenteric adenitis treatment. Mesenteric adenitis treatment may however be needed of there is persistence of the symptoms. The patient may be put on antibiotics if the inflammation is caused by bacteria.

Acetaminophen or Panadol or other pain killers may be prescribed to relieve pain. If the patient is vomiting, it should stay well hydrated by taking lots of fluids. Incase of severe vomiting there may be need of administration of oral or intravenous rehydration salts.

What are the possible complications of Mesenteric Adenitis?

As stated earlier, the mesenteric adenitis goes away in most cases without the requirement of medical treatment and it rarely causes complications. However, if the condition is caused by bacterial infection or other microorganisms, the causal organism may spread in to the body bloodstream and it may lead to sepsis- a serious condition that causes inflammation of the body tissues and organs.