What is the treatment for mesenteric adenitis?

Treatment of Mesenteric Adenitis

Mesenteric adenitis is a self-limiting inflammatory condition that typically requires only supportive care, including hydration and pain medication. 1

Diagnosis and Classification

Mesenteric adenitis is characterized by inflammation of the mesenteric lymph nodes, typically presenting with:

• Right lower quadrant abdominal pain
• Fever
• Possible leukocytosis
• Symptoms mimicking appendicitis or intussusception

Ultrasonography is the diagnostic method of choice, showing:

• 3 or more mesenteric lymph nodes with short-axis diameter ≥8 mm
• No identifiable underlying inflammatory process

Mesenteric adenitis can be classified as:

1. Primary Mesenteric Adenitis (PA) - no identifiable cause
2. Secondary Mesenteric Adenitis (SA) - associated with an underlying condition
3. Complicated Primary Mesenteric Adenitis (CPA) - with complications 2

Treatment Approach

Primary Mesenteric Adenitis

For uncomplicated primary mesenteric adenitis:

• Supportive care is the mainstay of treatment:

  • Adequate hydration (oral or IV if needed)
  • Pain management with appropriate analgesics
  • Rest as needed 2, 1

• No antibiotics are required for uncomplicated cases

• Reassurance to patients and families that complete recovery occurs within 2-4 weeks 1

Secondary Mesenteric Adenitis

When an underlying cause is identified:

• Treat the primary cause 2

• Common infectious causes include:

  • Yersinia enterocolitica
  • Salmonella species
  • Tuberculosis
  • Viral infections 3, 4

• For bacterial causes: Appropriate antibiotics based on the identified pathogen

  • For Salmonella: Consider antibiotics if systemic symptoms are present, as S. Enteritidis carries potential risk for serious complications 3
  • For tuberculosis: Standard anti-tuberculosis therapy 4
  • For typhoid fever: Appropriate antibiotic therapy 4

Complicated Cases

For cases with complications:

• Management should address the specific complication 2
• If peritonitis develops (rare): Surgical consultation may be warranted
• If abscess formation occurs: Consider drainage and antibiotics

Special Considerations

1. Differential Diagnosis:

   • Critical to differentiate from acute appendicitis, which may require surgical intervention
   • CT or ultrasound can help distinguish between these conditions 5

2. Laboratory Tests:

   • White blood count and C-reactive protein have limited usefulness in distinguishing mesenteric adenitis from other conditions 1
   • Consider stool cultures when infectious etiology is suspected 4

3. Follow-up:

   • Follow-up sonography may be useful to confirm resolution of adenopathy 3
   • Most patients recover completely without residual effects

Pitfalls to Avoid

• Misdiagnosing as appendicitis and performing unnecessary surgery
• Overuse of antibiotics in primary mesenteric adenitis
• Failing to identify and treat an underlying cause in secondary mesenteric adenitis
• Overlooking potential serious complications from certain pathogens (e.g., Salmonella)

Most patients with mesenteric adenitis improve spontaneously without specific treatment unless a pathogen requiring targeted therapy (such as tuberculosis or typhoid fever) is identified through microbiological testing.