Mesenteric adenitis

• What is mesenteric adenitis?


  Inflammation of mesenteric lymph nodes in abdomen

  Common mimic of appendicitis
• What are the RFs of mesenteric adenitis?


  Age (children & young adults)

  Immunosuppressed

  Prior GI disease
• What are the potential underlying causes of mesenteric adenitis?


  Infection (most common) (viral gastroenteritis, EBV, cytomegalovirus, adenoviruses)

  Autoimmune disorders (SLE, IBD)

  NOTE: mesenteric adenitis often occurs after initial infection has resolved -> indicates reactive process rather than ongoing infection of lymph nodes themselves
• Pathophys - mesenteric adenitis

  Exposure to pathogen -> invasion of intestinal lining -> replication & inflammation -> damaged tissue -> pathogens spread to mesenteric lymph nodes through lymphatic channels (can also enter bloodstream -> systemic infection) -> infected lymph nodes -> immune activation -> nodal enlargement (lymphadenopathy) & inflammation (adenitis) -> can lead to abdo pain
• What are the signs & symptoms of mesenteric adenitis?


  Diffuse abdo pain

  Nausea

  Diarrhoea

  Sore throat

  Hx of recent URTI or GI infection

  Low grade fever

  Generalised abdo tenderness

  Lymphadenopathy may be elsewhere (cervical/axillary nodes)

  Pharyngitis
• What are the DDx of mesenteric adenitis?


  Appendicitis

  Inflamed Meckel's diverticulum

  IBD

  Lymphoma
• What are the Inx of mesenteric adenitis?


  Obs

  Full Hx & examination

  Urinalysis (rule out UTI)

  Stool culture (if diarrhoea)

  Bloods (FBC, CRP)

  Abdo USS (can show enlarged lymph nodes)

  CT/MRI
• What is the management of mesenteric adenitis?

  Analgesia

  Ensuring sufficient fluid intake

  Abx (if bacterial cause)

  Monitoring for worsening symptoms

  Surgery (typically unnecessary)
• What are the possible complications of mesenteric adenitis?


  Peritonitis

  Bowel obstruction

  Sepsis

  Fistula formation (if chronic)
• Mesenteric adenitis an be primary or secondary...


  Primary

  • post-viral infections (up to 2 weeks)

  Secondary

  • appendicitis
  • other infections
  • IBD
  • SLE
  • sarcoidosis
  • malignancy
  • HIV infection
  • TB
• When should symptoms of mesenteric adenitis resolve?


  Few days