History

The disease may have a variable course, depending on the patient's age and condition and/or the pathogenic properties of the causative organisms.^[6]The onset and progression of mesenteric lymphadenitis 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 Examination

Although no set of physical findings is pathognomonic of mesenteric lymphadenitis, the following may be found in affected patients:

Fever (38-38.5°C)
Flushed appearance
Right lower quadrant (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

Classification

Mesenteric adenitis can be divided into two distinct groups: primary and secondary.^[1]

On imaging, primary mesenteric adenitis is described as right-sided mesenteric lymphadenopathy that does not have an identifiable acute inflammatory process or demonstrates only mild (< 5 mm) wall thickening of the terminal ileum.^[1]The etiology may be an underlying infectious terminal ileitis.

Secondary mesenteric adenitis on imaging studies demonstrates lymphadenopathy that is associated with a specific, identifiable intraabdominal inflammatory process.^[1]In the presence of clearly detectable terminal ileal thickening (eg, Crohn disease, infectious ileitis), the mesenteric adenitis is considered secondary.

Differential Diagnoses

Macari M, Hines J, Balthazar E, Megibow A. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR Am J Roentgenol. 2002 Apr. 178(4):853-8. [QxMD MEDLINE Link]. [Full Text].
Toorenvliet B, Vellekoop A, Bakker R, et al. Clinical differentiation between acute appendicitis and acute mesenteric lymphadenitis in children. Eur J Pediatr Surg. 2011 Mar. 21(2):120-3. [QxMD MEDLINE Link].
Moore MM, Kulaylat AN, Brian JM, et al. Alternative diagnoses at paediatric appendicitis MRI. Clin Radiol. 2015 Aug. 70(8):881-9. [QxMD MEDLINE Link].
Sanchez TR, Corwin MT, Davoodian A, Stein-Wexler R. Sonography of abdominal pain in children: appendicitis and its common mimics. J Ultrasound Med. 2016 Mar. 35(3):627-35. [QxMD MEDLINE Link].
Gross I, Siedner-Weintraub Y, Stibbe S, et al. Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children. Eur J Pediatr. 2017 Feb. 176(2):199-205. [QxMD MEDLINE Link].
Zinczuk J, Wojskowicz P, Kisluk J, Fil D, Kemona A, Dadan J. Mesenteric lymphadenitis caused by Yersinia enterocolitica. Prz Gastroenterol. 2015. 10(2):118-21. [QxMD MEDLINE Link]. [Full Text].
Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ. 2009 Mar 9. 338:b716. [QxMD MEDLINE Link]. [Full Text].
Zviedre A, Engelis A, Tretjakovs P, Jurka A, Zile I, Petersons A. Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children. Medicina (Kaunas). 2016. 52(5):291-7. [QxMD MEDLINE Link]. [Full Text].
Koning JL, Naheedy JH, Kruk PG. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol. 2014 Aug. 44(8):948-55. [QxMD MEDLINE Link].
Ackerman SJ, Irshad A, Anis M. Ultrasound for pelvic pain II: nongynecologic causes. Obstet Gynecol Clin North Am. 2011 Mar. 38(1):69-83, viii. [QxMD MEDLINE Link].
Ja Lim K, Lee K, Yoon DY, et al. The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases. Acta Radiol. 2015 Feb. 56(2):228-33. [QxMD MEDLINE Link].
Sheridan AD, Ehrlich L, Morotti RA, Goodman TR. Sonographic distinction between acute suppurative appendicitis and viral appendiceal lymphoid hyperplasia ("pink appendix") with pathological correlation. Ultrasound Q. 2015 Jun. 31(2):95-8. [QxMD MEDLINE Link].
Zu DM, Feng LL, Zhang L, Ma SL, Zhu YC. Evaluation of mesenteric lymph nodes in a pediatric population with mesenteric lymphadenitis using superb microvascular imaging. Med Sci Monit. 2019 Jul 18. 25:5336-42. [QxMD MEDLINE Link]. [Full Text].
Helbling R, Conficconi E, Wyttenbach M, et al. Acute nonspecific mesenteric lymphadenitis: more than "No need for surgery". Biomed Res Int. 2017. 2017:9784565. [QxMD MEDLINE Link]. [Full Text].
Mehmood A, Ehsan A, Mukhtar M, Inayat F, Ullah W. Acute mesenteric tuberculous lymphadenitis: a comparative analysis of twenty-one cases. Cureus. 2019 Apr 13. 11(4):e4454. [QxMD MEDLINE Link]. [Full Text].

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Author

Alan S Putrus, MBChB Fellow, Department of Gastroenterology, St John Providence/Providence Park Hospital

Alan S Putrus, MBChB is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, Chaldean American Association for Health Professionals, Iraqi Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

Burt Cagir, MD, FACS Associate Regional Dean and Professor of Surgery, Geisinger Commonwealth School of Medicine; Director, General Surgery Residency Program, Executive Director, Donald Guthrie Foundation for Research and Education, Guthrie Robert Packer Hospital; Medical Director, Guthrie/RPH Skills and Simulation Lab; Associate in Surgery, Guthrie Robert Packer Hospital and Corning Hospital

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, Association of Program Directors in Surgery, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Oluyinka S Adediji, MD, MBBS Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama

Oluyinka S Adediji, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Vivek V Gumaste, MD Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Jennifer Lynn Bonheur, MD Attending Gastroenterologist

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, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Mukul Arya, MD Associate Professor of Internal Medicine, Weill Cornell Medical College; Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center

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, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Mesenteric Lymphadenitis Clinical Presentation

History

Physical Examination

Classification

References

Tables

Contributor Information and Disclosures

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