eMedicine Specialties > Gastroenterology > Intestine

Mesenteric Lymphadenitis

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

Introduction

Background

Mesenteric lymphadenitis refers to inflammation of the mesenteric lymph nodes. This process may be acute or chronic, depending on the causative agent. It causes a clinical presentation that is often difficult to differentiate from acute appendicitis.

Pathophysiology

Microbial agents are thought to gain access to the lymph nodes via the intestinal lymphatics. Organisms subsequently multiply and, depending on the virulence of the invading pathogen, elicit varying degrees of inflammation and, occasionally, suppuration.

Grossly, the lymph nodes are enlarged and often soft. The adjourning mesentery may be edematous, with or without exudates. If a contiguous primary source of infection (eg, the appendix) is present, evidence of inflammation is often apparent.

Microscopically, the lymph nodes show nonspecific hyperplasia and, in suppurative infection, necrosis with numerous pus cells.

Frequency

United States

The true incidence of this disease is not known, because it can be easily missed or mistaken for other diagnoses. The condition is generally thought to be common. Up to 20% of patients undergoing appendectomy have been found to have nonspecific mesenteric adenitis.

International

Frequency is similar to that of the United States. Yersinia enterocolitica infection has a geographic variation. This infection is most common in the temperate countries of Europe, North America, and Australia; it has been particularly noted in Eastern Europe.

Mortality/Morbidity

Mesenteric lymphadenitis generally is a benign disease, but patients with sepsis may have a fatal outcome.

Sex

The condition affects males and females equally. Yersinia infection is more common in boys than in girls.

Age

Mesenteric lymphadenitis can occur in adults but is more common in children and adolescents younger than 15 years, and this condition during childhood or adolescence is linked to a significantly reduced risk of ulcerative colitis in adulthood.1

Frisch et al reviewed Swedish and Danish cohort studies involving 709,353 patients who had undergone appendicectomy and were followed up for subsequent ulcerative colitis to determine the role of appendicitis and mesenteric lymphadenitis in the risk of ulcerative colitis following appendicectomy.1 The investigators also studied the impact of appendicectomy in 224,483 patients with a family history (parents or siblings) of inflammatory bowel disease and found that regardless of familial predisposition to inflammatory bowel disease, appendicitis and mesenteric lymphadenitis during childhood or adolescence is linked to a significantly reduced risk of ulcerative colitis in adulthood.1

Clinical

History

Onset and progression may be insidious or sometimes dramatic. Clinical features of associated organ involvement, such as enterocolitis or ileitis in Yersinia infection, may be present. Clinical presentations include the following:

  • 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)
  • History of ingestion of raw pork may be obtained in areas with endemic Yersinia (eg, Belgium).

Physical

No set of physical findings is pathognomonic of mesenteric lymphadenitis.

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

Causes

  • Numerous organisms have been cultured from mesenteric lymph nodes and blood.
    • Organisms include beta-hemolytic streptococcus, Staphylococcus species, Escherichia coli, Streptococcus viridans, Yersinia species (responsible for most cases currently), Mycobacterium tuberculosis, Giardia lamblia, and non– Salmonella typhoid.
    • Viruses, such as coxsackieviruses (A and B), rubeola virus, and adenovirus serotypes 1, 2, 3, 5, and 7, have been implicated.
  • Mesenteric node involvement can also be part of infectious Epstein-Barr virus (EBV), acute human immunodeficiency virus (HIV) infection, and catscratch disease (CSD).
  • The frequent association of this condition, especially in children with upper respiratory tract infection, has popularized a theory that swallowed pathogen-laden sputum may be the primary source of infection.
  • Fecal-oral transmission occurs in Y enterocolitica infection and may present as a common source outbreak. This infection has also been associated with meat, milk, and water contamination. Rarely, person-to-person or zoonotic contacts with fecal carriers can lead to infection.

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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