eMedicine Specialties > Gastroenterology > Intestine

Mesenteric Lymphadenitis: Follow-up

Author: Jennifer Lynn Bonheur, MD, Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Coauthor(s): Mukul Arya, MD, Associate Professor of Internal Medicine, Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center/Weill Medical College; Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama; Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center
Contributor Information and Disclosures

Updated: Aug 5, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is indicated for patients with complications. When the diagnosis is not clear, admission for observation may be necessary.

Further Outpatient Care

  • Schedule early outpatient follow-up visits to ensure complete resolution of symptoms.
  • No further diagnostic tests are required for patients who recover completely. This is the case for most patients.

Complications

  • Volume depletion and electrolyte imbalance in patients with severe diarrhea, nausea, and vomiting
  • Abscess formation
  • Peritonitis (rare)
  • Sepsis
  • In cases where the underlying pathogen is Y enterocolitica, some patients may develop arthralgias. These symptoms typically develop 1 month after the initial episode of diarrhea and usually resolve after 1-6 months. A rash on the legs and/or trunk, erythema nodosum, may also appear and is also self-limited.

Prognosis

  • Prognosis is good. Typically, complete recovery can be expected without specific treatment. Death is rare.

Patient Education

  • Explain the benign nature of the disease to patients; however, because there is a risk of recurrence, also explain that they must seek prompt medical attention in each instance to exclude other more emergent etiologies.
  • In cases of Yersinia infection as the underlying infectious agent, instruct patients to avoid unpasteurized milk, raw pork (particularly chitterlings), and contaminated water.

Miscellaneous

Medicolegal Pitfalls

  • Given the nonspecific signs and symptoms associated with mesenteric adenitis and the numerous associated differential diagnoses, the primary goal must be to avoid missing a potentially life-threatening condition (eg, acute appendicitis) and a delay in appropriate surgical and medical intervention.
  • Conversely, in less complicated cases, surgery and/or ineffective antibiotics may be used without benefit to the patient if the diagnosis is made incorrectly.
 


More on Mesenteric Lymphadenitis

Overview: Mesenteric Lymphadenitis
Differential Diagnoses & Workup: Mesenteric Lymphadenitis
Treatment & Medication: Mesenteric Lymphadenitis
Follow-up: Mesenteric Lymphadenitis
References
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References

  1. Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ. Mar 9 2009;338:b716. [Medline]. [Full Text].

  2. Arrese M, Lopez F, Rossi R. Extrahepatic cholestasis attributable to tuberculous adenitis. Am J Gastroenterol. May 1997;92(5):912-3. [Medline].

  3. Asch MJ, Amoury RA, Touloukian RJ. Suppurative mesenteric lymphadenitis. A report of two cases and review of the literature. Am J Surg. Apr 1968;115(4):570-3. [Medline].

  4. Blattner RJ. Acute mesenteric lymphadenitis. J Pediatr. Mar 1969;DA - 19690327(3):479-81. [Medline].

  5. Campbell GL, Dennis TD. Plague and Other yersinia infections. In: Fauci AS et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;1998:975-983.

  6. Currie B. Yersinia enterocolitica. Pediatr Rev. Jul 1998;19(7):250; discussion 251. [Medline].

  7. Daly JM, Adams JT, et al. Abdominal wall, Omentum, Messentery and Retroperitoneum. In: Schwarttz ST et al, eds. Principles of Surgery. 7th ed. New York, NY: McGraw-Hill Health Professions Div;1999:1574-1575.

  8. Faller DV. Diseases of Lymph nodes and Spleen. In: Bennet JC et al, eds. Cecil Textbook of Medicine. WB Saunders;1996:1968-970.

  9. Kelly CS, Kelly RE Jr. Lymphadenopathy in children. Pediatr Clin North Am. Aug 1998;45(4):875-88. [Medline].

  10. Morris Jr JG. Yersinia infections. In: Bennet JC et al, eds. Cecil textbook of Medicine. WB Saunders;1996:1661.

  11. Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology. 1997;202:145-149.

  12. Schrock TR. Appendicitis. Gastrointestinal and Liver Disease, 6th Edition. 1998;1782.

  13. Sivit CJ. Imaging children with acute right lower quadrant pain. Pediatr Clin North Am. Jun 1997;44(3):575-89. [Medline].

  14. Zganjer M, Roic G, Cizmic A. Infectious ileocecitis--appendicitis mimicking syndrome. Bratisl Lek Listy. 2005;106(6-7):201-2.

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Further Reading

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Keywords

mesenteric lymphadenitis, mesenteric adenitis, mesenteric lymph nodes, intestinal lymphatics, Yersinia enterocolitica infection, peripheral lymphadenopathy, infectious Epstein-Barr virus, EBV, acute human immunodeficiency virus, HIV, catscratch disease, CSD, acute appendicitis

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Contributor Information and Disclosures

Author

Jennifer Lynn Bonheur, MD, Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Academy of Sciences, New York Society for Gastrointestinal Endoscopy, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Mukul Arya, MD, Associate Professor of Internal Medicine, Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center/Weill Medical College
Mukul Arya, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Oluyinka S Adediji, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center
Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Vivek V Gumaste, MD, Associate Professor of Medicine, Mt Sinai School of Medicine; Adjunct Clinical Assistant, Mt Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center
Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas M Heuman, MD, FACP, FACG, AGAF, Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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