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Mesenteric Adenitis

Mesenteric Adenitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Inflammation of the mesenteric lymph nodes; a common cause of self-limited RLQ abdominal pain

Description

  • Characterized by benign inflammation of the mesenteric lymph nodes; can be acute or chronic, primary or secondary
  • May clinically mimic acute appendicitis

Epidemiology

  • Commonly misdiagnosed, making definitive incidence difficult to determine
  • Most common cause of appendicitis-like pain in children (1)
    • 20% in patients presenting for appendectomy (1)
    • More common than acute appendicitis <10 years (2)
  • More common in children <15 years old than in adults
    • Primary adenitis is more common in children.
    • Secondary adenitis is more common in adults.
      • Rule out diverticulitis, appendicitis, Crohn disease, or systemic infectious/inflammatory disease (e.g., HIV, SLE, sarcoidosis).

Prevalence

Affects males and females equally

  • Adenitis secondary to Yersinia infection is more prevalent in boys than girls.
    • Yersinia enterocolitica is most common in North America, Eastern Europe, and Australia.

Etiology and Pathophysiology

  • Primary: underlying inflammatory process not present; presumed due to acute infectious gastroenteritis (specifically, terminal ileitis)
  • Secondary: underlying inflammatory process present
  • In infectious cases, pathogens are ingested, translocate through the intestinal epithelium via Peyer patches, and gain access to mesenteric lymph nodes where an inflammatory reaction causes symptoms and clinical disease:
    • Y. enterocolitica
    • Campylobacter jejuni
    • Salmonella typhi
    • β-Hemolytic Streptococcus spp.
    • Staphylococcus spp.
    • Streptococcus viridans
    • Escherichia coli
    • Mycobacterium tuberculosis
    • Giardia lamblia
    • Epstein-Barr virus (EBV) (mononucleosis)
    • Acute HIV infection
    • Rubeola virus
    • Bartonella henselae (cat-scratch disease)
    • Adenovirus species
    • Toxoplasma gondii

Genetics
No known genetic susceptibility

Risk Factors

  • Typically preceded by URI or pharyngitis
  • History of ingesting undercooked pork particularly in areas where Yersinia is endemic (parts of Europe)

General Prevention

Minimize risk by fully cooking foods, especially meat.

Commonly Associated Conditions

  • Appendicitis
  • Diverticulitis
  • Crohn disease
  • Celiac disease
  • Other systemic inflammatory/autoimmune disease

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Citation

Stephens, Mark B., et al., editors. "Mesenteric Adenitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688212/all/Mesenteric_Adenitis.
Mesenteric Adenitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688212/all/Mesenteric_Adenitis. Accessed April 24, 2019.
Mesenteric Adenitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688212/all/Mesenteric_Adenitis
Mesenteric Adenitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688212/all/Mesenteric_Adenitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Mesenteric Adenitis ID - 1688212 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688212/all/Mesenteric_Adenitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -