Mesenteric Lymphadenitis Clinical Presentation

Updated: Oct 23, 2019
  • Author: Alan S Putrus, MBChB; Chief Editor: Burt Cagir, MD, FACS  more...
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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



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.