Mesenteric Lymphadenitis in Children: Single Centre Study in a Rural Hospital

Abstract

Background: Mesenteric lymphadenitis is a well recognised entity that is often misdiagnosed as acute appendicitis in children. It presents with right lower quadrant pain and fever. Ultrasonography is the main modality used to diagnose this condition apart from a strong clinical suspicion.

Aim:  The aim was to study the clinical profile. evaluate the etiology and management outcomes of mesenteric lymphadenitis in children.

Material and methods: This is a prospective study done on hundred children who attended the paediatric medical and paediatric surgical OPD’s of MMIMSR (Maharishi Markandeshwar University of Medical Sciences And Research), Mullana, Ambala over a period of 24 months from August 2014 to August 2016. Enlarged lymph nodes more than 10mm, their size and location were recorded. Only 60  children who fulfilled the inclusion criteria of having mesenteric lymphadenitis of short axis diameter more than 10mm were studied and their clinical profiles and management outcomes were evaluated.

Results:All patients were between 1 and 15 years of age (Average age was 8 years). A total of 60 patients were included in the study. 75% of the patients (n=45) were males and 25% (n=15) were females. Pain with tenderness in right iliac fossa was the most common presenting feature in all patients accounting for 100% (n=60) cases followed by cold and cough in 33.3% (n=20) cases, diarrhoea in 16.6% (n=10) cases, vomiting and fever in 8.3% (n=5) cases. The commonest cause of mesenteric lymphadenitis was found to be idiopathic in 41.7%, upper respiratory tract infection in 25%, diarrhoea in 16.7%, urinary tract infection in 8.3%, worm infestation in 5% and enteric fever in 3.3% patients. Most of the patients (63.3%) improved spontaneously without using antibiotics.

Conclusion:  Enlarged mesenteric lymph nodes cause abdominal pain in children. This entity has to be kept in mind as a differential diagnosis in any child who presents with pain abdomen. It is a self limiting disease and ultrasound is the diagnostic tool. A correct diagnosis can avoid unnecessary surgical intervention and majority of cases resolve with conservative treatment