Mesenteric Adenitis refers to a condition when the mesentery lymph nodes become inflamed. It frequently occurs in children and teenagers, and rarely affects people over the age of 20.
The mesentery is a fold of membrane that attaches your intestine to your abdominal wall. It contains dozens of lymph nodes and connects your lymphatic system. The lymphatic system is important because it filters harmful substances like bacteria and viruses and maintains body fluid balance by draining fluids that leak out of your blood vessels. This article talks about Mesenteric Adenitis, its causes and treatment.
The accurate scale of mesenteric adenitis is never known due to its self-resolving nature and frequent misdiagnosis. Up to 20% of patients undergoing appendix removal surgery have been found with nonspecific mesenteric adenitis.
Mesenteric adenitis is usually caused by a bacterial or viral infection of the gastrointestinal tract. Children’s immunity is particularly weak compared to that of adults, which explains the high prevalence among the paediatric population. Common bacteria causing stomach flu include E. coli, Salmonella, Campylobacter and Shigella. The single most common virus is Norovirus.
When the virus or bacteria lodges in your gastrointestinal tract, your immunity attracts chemical molecules and white blood cells to launch an attack, which results in local inflammation. Your local lymph nodes are important sites for immunity to be launched. However, when there are too many invading organisms, or too many inflammatory molecules being produced, your lymph nodes are overwhelmed and can exacerbate your symptoms.
Because there are dozens of lymph nodes clustered around the appendix, symptoms of mesenteric adenitis resemble that of appendicitis. These include:
- Lower right abdominal pain
- Generalized abdominal pain
- Loss of appetite
- Nausea and vomiting
Careful evaluation and investigation are required to reach the diagnosis of mesenteric adenitis. Blood tests and imaging are commonly used for diagnosis.
- Blood test: Your doctor might order a blood test to screen for raised inflammatory markers. An increased white blood cell count is usually indicative of an active inflammatory process.
- Imaging: Abdominal ultrasonography is the first-line imaging technique to look for enlarged lymph nodes. In some hospitals, microvascular flow imaging is combined with ultrasound to visualize the blood and lymph flow.
As mentioned above, many lymph nodes in your mesentery cluster around the appendix. Therefore, lymph node enlargement can also present in acute appendicitis and perforated appendicitis. To be safe, your doctor might suggest a keyhole surgery to investigate further. During the procedure, the unhealthy appendix can also be removed to prevent future appendicitis.
Though computerised tomography (CT) scan could be utilised if there are no clear ultrasound findings, CT scan is radioactive and is rarely used as an investigative tool in children and teenagers.
Mesenteric adenitis usually resolves by itself once the infection is cleared. However, symptomatic treatment might still be required. These include:
- Hydration: If you have lost a significant amount of fluid due to vomiting and diarrhoea, intravenous (IV) rehydration is required. This means fluid will be injected into your body through an intravenous line.
- Antibiotic: Your doctor might also give you broad-spectrum antibiotics (meaning antibiotics that act against an extensive range of bacteria) to eliminate the source of your infection.
- Pain Management: Paracetamol or nonsteroidal anti-inflammatory medications (NSAIDs) can be given for pain relief. NSAIDs have the additional function to reduce inflammation.
- Antiemetics: If you have symptoms of vomiting, you can consider taking antiemetics to prevent vomiting.
- Antidiarrheal Medications: This can slow down how fast things move through your intestines and help you feel better if you have diarrhoea.
Even after your symptoms resolve, it is important for you to make follow-up appointments with your doctor to monitor your progress and discuss any concerns you might have.
Lifestyle prevention is important when it comes to Mesenteric Adenitis.
- Avoid raw or half-cooked meat
- Avoid street food, especially during travel
- Wash or sanitise hands before eating and drinking
- Keep the kitchen clean and disinfect before or after cooking
- For children, avoid contact as much as possible with other sick kids or adults
Though mesenteric adenitis is usually self-resolving and does not have significant complications, it is important for parents to keep an eye on their children for symptoms. If there is severe dehydration due to fluid loss, hospitalisation could still be required. Current imaging techniques have enhanced diagnostic accuracy in comparison to the past and can help greatly with diagnosis. If you have abdominal pain or any of the above symptoms, and you are unsure of what is wrong, do visit your doctor. He or she can conduct an examination or assessment for you to rule out other possible causes of lower abdominal pain such as appendicitis, ovarian torsion and ectopic pregnancy.