Mesenteric adenitis

Question 1

What is mesenteric adenitis?

Answer 1

Mesenteric adenitis is inflamed lymph nodes within the mesentery.

=> presents with a diffuse abdominal pain

=> it can cause similar symptoms to appendicitis and can be difficult to distinguish between the two

=> often follows a recent viral infection or URTI and needs no treatment

Question 2

What are the symptoms for mesenteric adenitis?

Answer 2

Low grade fever

Generalised abdominal tenderness

Pharyngitis might be present

Children present quite well with no changes in appetite

*Abdo ultrasound shows enlarged mesenteric lymph nodes with normal appendix
=> appendix now always visible on USS so important to take clinical presentation into account when ruling out appendicitis

Question 3

How is mesenteric adenitis managed?

Answer 3

Monitored overnight to look for worsening clinical status or safety netted about returning if appendicitis symptoms occur

=> mesenteric adenitis improves spontaneously; appendicitis doesn’t

Question 4

Any child presenting with severe abdominal pain must be worked up for appendicitis.

However, the definitive treatment for appendicitis is surgery, and in children this cannot be performed laparoscopically due to a smaller abdominal cavity. => thus option to go to surgery must be used with caution.

Answer 4

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