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Mesenteric Adenitis: Symptoms, Causes, and Treatment

Mesenteric Adenitis: Symptoms, Causes, and Treatment

Introduction

Mesenteric adenitis is the inflammation of the lymph nodes present in the mesentery, which is the membrane that attaches the small intestine to the abdominal cavity wall. It usually causes abdominal pain, especially in children and teenagers. 

Lymph nodes contain lymphocytes, which are white blood cells (WBCs). Lymph nodes are also a part of the body’s lymphatic system. They tend to filter out unwanted elements in the body such as bacteria, other harmful microorganisms, and toxic substances. The condition is also called as mesenteric lymphadenitis.

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What are the symptoms of mesenteric adenitis?

It has been seen that upper respiratory tract infections tend to occur first and cause sore throat symptoms before the symptoms of mesenteric adenitis are observed. The following are common symptoms of mesenteric adenitis:

  • High fever
  • Lower or central abdominal pain or tenderness

Other signs and symptoms depend on what causes the inflammation. They include:

Mesenteric Adenitis vs. Appendicitis

The symptoms of appendicitis and mesenteric adenitis are quite similar. In appendicitis, the appendix is inflamed, which causes a sharp pain from the upper abdomen to the lower right abdominal region. The two conditions are sometimes difficult to identify.

In mesenteric adenitis, pain can be experienced in other parts of the abdomen. The symptoms usually start due to a viral infection or cold. However, in appendicitis, the symptoms usually come all of a sudden. Appendicitis is more common than mesenteric adenitis.

Mesenteric adenitis usually resolves on its own, while most appendicitis cases are treated using the surgical removal of the inflamed appendix called appendectomy. However, uncomplicated appendicitis cases can also be treated using antibiotics and may not require surgery. 

Pathophysiology

The microbial agents are believed to gain access to the lymph nodes through the intestinal lymphatic system. Based on the virulence of the invading pathogen, the organisms are known to multiply and also elicit inflammation to varying degrees.  

The lymph nodes also tend to get enlarged and soft. The lymph nodes can be with or without exudates and may be edematous. Evidence of inflammation becomes apparent if the primary source of infection is present.

In a suppurative infection, the lymph nodes microscopically show nonspecific hyperplasia and necrosis with several pus cells.

Causes 

Infection is the most common cause of mesenteric adenitis. Other types of inflammation are also associated with mesenteric adenitis.

Mesenteric adenitis is also often seen after viral gastroenteritis or commonly called as the stomach flu. Stomach flu may cause the lymph nodes in and around the mesentery to become inflamed. The lymph nodes become swollen and inflamed in response to bacterial or viral infections. Lymph nodes help prevent a person from getting sick by trapping bacteria, viruses, and other harmful substances. 

After a respiratory tract infection, mesenteric adenitis may also occur. Mesenteric adenitis can also be due to gastroenteritis due to the bacterium Yersinia enterocolitica. The condition can also be caused by inflammatory bowel disease (IBD) or less often in certain types of cancer, which include:

The infections that lead to mesenteric adenitis may either be local (only in one place) or systemic (all throughout the body). The common infections are:

  • Y. enterocolitica - This bacterium is quite commonly seen as a cause of mesenteric adenitis in children. Its symptoms are often similar to appendicitis or Crohn’s disease. 

Other infections include:

  • Tuberculosis - A bacterial infection that attacks the lungs.
  • Acute Terminal Ileitis - Inflammation in the last part of the intestine.
  • Infections - Those that are associated with HIV that can lead to AIDS.

Inflammatory conditions linked with mesenteric adenitis are:

Etiology

A lot of microorganisms have been cultured from the blood and mesenteric lymph nodes. They include:

  • Beta-hemolytic Streptococcus
  • Escherichia coli
  • Staphylococcus species
  • Yersinia species
  • Streptococcus viridans
  • Giardia lamblia
  • Mycobacterium tuberculosis
  • Non–typhoidal Salmonella 

Implicated viruses include:

  • Coxsackieviruses (A and B)
  • Adenovirus serotypes 1, 2, 3, 5, and 7
  • Rubeola virus (measles)

Mesenteric lymph nodes are said to be involved with the following infections:

  • Acute HIV
  • Cat-scratch disease (CSD)
  • Epstein-Barr virus (EBV)

Usually, mesenteric adenitis is associated with upper respiratory tract infections in children.

Infections caused by Y. enterocolitica involve fecal-oral transmissions. It can also be a common source of an outbreak through contaminated water, milk, and meat. Person-to-person contact can rarely lead to the infection.

Risk Factors 

Mesenteric adenitis may occur at any age. However, the condition is more commonly seen in children. Mesenteric adenitis may also occur in children after having the following conditions:

  • Respiratory infections such as colds 
  • Stomach flu
  • Consuming undercooked pork contaminated with Y. enterocolitica bacteria

When to See a Doctor

It is common for children to experience stomachaches, and most of the time, they are not serious. However, seek immediate medical attention if your child experiences the following symptoms:

  • Sudden and severe abdominal pain
  • Abdominal pain accompanied by diarrhea, weight loss, and vomiting
  • Persistent or worsening gastrointestinal symptoms
  • Pain interferes with sleep
  • Loss of appetite
  • Unusual bowel movements

At times, the symptoms of mesenteric adenitis can be easily confused with the symptoms of ectopic pregnancy and appendicitis. 

Diagnosis

The doctor usually asks about the symptoms of your child. Doctors will also ask if your child had a recent infection such as colds, flu, stomach flu, and other types of infection. The doctor may also check your child’s tummy and look for swelling or any tenderness in the abdominal region that may indicate enlarged lymph nodes.

A blood sample can also be taken to identify if there is an infection. Imaging tests may be ordered to look for swollen or enlarged abdominal lymph nodes.

Below are tests that can be used to accurately distinguish mesenteric adenitis from acute appendicitis:

  • CT Scan – It is a type of imaging test that utilizes a series of detailed X-ray images of the abdomen.
  • Ultrasound – Uses high-frequency sound waves to show images inside the abdomen. 

Preparing for an Appointment

Make an appointment with your family doctor or pediatrician if your child has signs and symptoms similar to mesenteric adenitis. The following information will help you get ready for your doctor's appointment.

  • Symptoms experienced by your child - They include nonabdominal symptoms, too. Take note of the time when you first noticed the symptoms. Check and take note of your child's temperature several times.
  • Medical history of your child - It includes any health conditions and medications, supplements, or vitamins taken by your child. Bring your child's vaccination record as well.
  • Personal information - Any recent stress or lifestyle changes in your child’s life.
  • Questions - You can make a list of questions that you would like to ask the doctor.

Some of these questions could be:

  • What could cause mesenteric adenitis?
  • What are the other possible causes for your child's condition?
  • What are the tests needed?
  • Are there any risks or complications?
  • What kind of treatment is needed? Is antibiotic therapy needed?
  • What types of food should be avoided? How can your child be made more comfortable?
  • How will I know if my child is recovering?
  • Is my child's condition contagious?
  • When can my child resume school?

Treatment

Mesenteric adenitis usually gets better without treatment. However, antibiotic therapy may be needed in children with a bacterial infection. Do not give aspirin when your child has a fever. Give over-the-counter analgesics such as acetaminophen or ibuprofen instead. Some mild cases often resolve on their own. 

Other treatment options include:

  • Getting enough rest. 
  • Drinking plenty of fluids to avoid dehydration.
  • Applying heat to ease the pain in the abdominal area.

Home Remedies 

Some home remedies or natural treatment methods may help support the immune system to effectively fight any kind of infection. 

  • Echinacea - It is derived from the Echinacea plant. It is an herb used to fight infections. It helps remove toxins in the body and boosts the immune system. It also speeds up the healing process.
  • Licorice - It has anti-inflammatory properties that can help treat a variety of infections. It also enhances mucosal protection by providing the intestinal tract with healthy bacteria.
  • Wild Indigo - It is an herb with infection-fighting properties. It can be toxic if used alone, so it should be used in combination with Echinacea. It can help fight disease by cleansing the lymphatic system.

However, it is important to note that there is still no hard evidence when it comes to the effectiveness of these natural remedies.

Prevention

Mesenteric adenitis is a condition that cannot be always avoided. However, it can be possible to reduce the risk of bacterial and viral infections. The following tips can be done to help reduce the risk of mesenteric adenitis:

  • Wash your hands regularly using soap and water. Good handwashing habits can help eliminate harmful microorganisms as well as prevent the spread of infections.
  • Avoid close contact with people who are sick.
  • The area where food is prepared should be kept clean. Some areas that could be contaminated such as bathrooms should be regularly disinfected.

Prognosis and Complications

Prognosis is usually good in mesenteric adenitis cases. Complete recovery of an individual without a specific treatment can be expected.

Death rarely occurs due to mesenteric adenitis. Mesenteric adenitis is actually a benign condition, but a fatal outcome may occur in patients with sepsis.

This condition is usually not serious, but has been associated with other conditions such as:

  • Gastrointestinal Problems - Severe diarrhea and vomiting leading to dehydration.
  • Abdominal Abscess - Pocket of pus in the abdominal cavity.
  • Arthralgia (Joint Pain) - This condition is known to occur when the underlying pathogen is Y. enterocolitica. 
  • Peritonitis - The membrane surrounding the organs in the abdomen gets inflamed. However, this condition rarely occurs.
  • Sepsis - Systemic inflammatory response due to infection.

Outlook

Mesenteric adenitis is not a serious condition and should improve on its own after a few days. However, there is a low risk of ulcerative colitis associated with mesenteric adenitis. Ulcerative colitis is one of the two forms of inflammatory bowel disease. 

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