Mesentric lymphadenopathy

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Mesentric lymphadenopathy

• Dr Rajesh Kumar
• 28/11/07

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• 10 years boy
• Admitted with vomiting, pain abdomen
• USG Mesentric Lymphadenitis
• Treated with IVF, antibiotics, better, ATT
  started in view of fever on and off previously
• Later diagnosed as ALL

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• 8 years male
• Pain abdomen , lump in andomen
• USG Mesentric Adenitis, Mx Positive
• Started on ATT, minimum response
• BM normal
• Later symptoms continues
• Later Burkitts Lymphoma on FNAC

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• Acute syndrome
• Acute pain abdomen
• Chronic Syndrome
• Pain abdomen
• Failure to thrive

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Acute Mesentric Lymphadenitis

• It is a self-limited inflammatory process that
  affects the mesenteric lymph nodes in the right
  lower quadrant.
• Its clinical presentation mimics that of acute
  appendicitis.
• Previously, the diagnosis was most frequently
  made during laparotomy
• Cross-sectional imaging has made the diagnosis
  easier

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Etiology

• Viral pathogens commonest
• Others
• Yersinia enterocolitica,
• Helicobacter jejuni,
• Campylobacter jejuni,
• Salmonella or Shigella species

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• Mesenteric lymph nodes are present near
  mesenteric vessels and between bowel loops.
• The normal mesenteric lymph node vary in size,
  but, in general, the short-axis diameter is 4 mm
  or shorter

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Symptoms

• Abdominal pain - Often right lower quadrant (RLQ)
  but may be more diffuse
• Fever
• Diarrhea
• Malaise
• Anorexia
• Concomitant or antecedent upper respiratory tract
  infection
• Nausea and vomiting (which generally precedes
  abdominal pain, as compared to the sequence in
  appendicitis)

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Signs

• Fever (38-38.5C)
• Flushed appearance
• RLQ tenderness - Mild, with or without rebound
  tenderness
• Voluntary guarding rather than abdominal rigidity
• Rhinorrhea
• Hyperemic pharynx
• Toxic appearance
• Associated peripheral lymphadenopathy (usually
  cervical) in 20 of cases

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D/D

• Acute appendicitis
• Regional enteritis
• Meckels diverticulitis
• Neoplasms
• TB

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CLINICAL PROFILE OF MESENTERIC LYMPHADENITIS IN
CHILDREN Sathish .K, Paramesh.H, Hemalatha .V,
Salim.A. Khatib

• According to study done in A.I.I.M.S. from
  January 2003 to September 2003,40 of children
  who had undergone appendicectomy were found to
  have normal appendix by histopathology. 20of
  children who underwent surgery for appendicitis
  were found to have mesenteric adenitis, with
  normal appendix.

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Medical Vs Surgical

• Surgical Pain precedes vomiting
• Medical Vomiting precedes pain

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USG

• In patients with fever, abdominal tenderness, and
  a normal appendix, adenopathy that predominantly
  involves but is not limited to the right lower
  quadrant suggests the diagnosis
• Usually, 5 or more nodes are present and often
  clustered
• Abnormal nodes have a short-axis diameter of at
  least 5 mm, and this can exceed 1 cm. The nodes
  are typically larger and more numerous with
  mesenteric adenitis than with appendicitis
• Demonstration of hyperemia within the node and
  surrounding mesentery with Doppler imaging is
  variably reported
• Other findings include intestinal
  hyperperistalsis, which is seldom observed in
  appendicitis nodular or circumferential
  thickening of the bowel wall mesenteric
  thickening fluid-filled loops cecal
  involvement and free fluid

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Antibiotics

• trimethoprim-sulfamethoxazole (TMP-SMX),
• third-generation cephalosporins
• fluoroquinolones,
• Aminoglycosides
• doxycycline

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Yersinia enterocolitica

• Large gram negative cocco-bacilli
• Entry through alimentary tract, mucosal
  ulceration in the ileum, necrotic patches in
  peyers pathches, mesentric adenitis

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Yersinia Mode of Transmission

• Y. enterocolitica is transmitted via the
  fecal-oral route
• Most often transmitted by eating or drinking food
  or water that has been contaminated by contact
  with infected animals or people
• Reservoirs animals
• Nosocomial transmission has been reported. Also
  reports of transmission by transfusion of stored
  blood from asymptomatic donors is reported

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Target Populations
The most susceptible populations for the disease
and possible complications are the very young,
the debilitated, the very old and persons
undergoing immunosuppressive therapy. The
severity of the disease is largely dependent upon
the age, immune status and other predisposing
factors.
Cover T. L. (1995) Infections of gastrointestinal
tract. 811-823
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Clinical Manifestation

• Severe gastroenteritis characterized by fever,
  abdominal pain, and diarrhea
• In older children and adults, right-sided
  abdominal pain and fever are predominant symptoms
  which might be confused with appendicitis
• More invasive syndromes include terminal ileitis
  and mesenteric lymphadenitis
• In immunocompromised hosts bacteria may spread to
  the bloodstream causing septicemia

Post-infectious sequelae 25 of the cases
develop erythema nodosum (skin rash on legs and
trunk), reactive arthritis (pain in joints) or
Reiters syndrome (a combination of arthritis,
conjunctivitis and urethritis)
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Antibiotics

• Self limiting
• TMP-SMZ
• Aminoglycoside
• Cephalosporins
• Quinolones

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Campylobacter

• 12 species, jejuni, coli
• Thin curved gram negative rods
• Infection by taking contaminated food or drink
• Perinatal transmission also

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Manifestations

• Acute gastroenteritis
• Mesentric adenitis
• Focal enteritis
• Bactermia
• Extraintestinal manifesttation in
  immunocompromised

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Complications

• Reactive arthritis
• 5-40 Days after AGE
• Large joints
• Resolves without sequele
• GBS
• 1-12 weeks later

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Antibiotics

• Macrolide
• Aminoglycoside
• Chloramphenicol
• Imipenem
• Resistant to cephalosporins, penicillins,
  TMP-SMZ
• Quinolones