What is the management approach for mesenteric lymphadenitis?

Management of Mesenteric Lymphadenitis

Mesenteric lymphadenitis is a self-limiting inflammatory condition that should be managed with supportive care including hydration and pain medication, with nonsteroidal anti-inflammatory drugs as first-line treatment for mild cases. 1

Definition and Clinical Presentation

• Mesenteric lymphadenitis is a self-limiting inflammatory condition affecting the mesenteric lymph nodes, whose presentation often mimics appendicitis or intussusception 1
• It typically affects children, adolescents, and young adults, with a higher prevalence in children under 3 years of age 2, 1
• Patients commonly present with abdominal pain, which may be accompanied by low-grade fever and anorexia 3

Diagnosis

• Ultrasonography is the mainstay of diagnosis, revealing 3 or more mesenteric lymph nodes with a short-axis diameter of 8 mm or more without any identifiable underlying inflammatory process 1
• Laboratory tests including white blood cell count and C-reactive protein have limited usefulness in distinguishing mesenteric lymphadenitis from other conditions 1
• CT scan may be used to confirm diagnosis and rule out other pathologies, especially in cases where the clinical presentation is atypical 3

Treatment Algorithm

Mild Cases (No Systemic Symptoms)

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line therapy 2
• Adequate hydration should be maintained 1
• Reassurance to patients and families is crucial, explaining that complete recovery without residual effects typically occurs within 2-4 weeks 1

Severe Cases (With Systemic Symptoms)

• In cases with compression of contiguous structures, prednisone (0.5–1.0 mg/kg daily with a maximum of 80 mg daily in tapering doses over 1–2 weeks) may be considered 2
• If symptoms persist or worsen despite conservative management, further diagnostic evaluation may be necessary to rule out other conditions 4, 5

Special Considerations

• If mesenteric lymphadenitis is suspected to be secondary to an infectious cause (such as tuberculosis), specific treatment for the underlying condition should be initiated 6
• Laparoscopy may be considered for differential diagnosis in cases where the clinical presentation is unclear or if symptoms persist despite conservative management 5

Follow-up

• Most cases resolve completely within 2-4 weeks without any residual effects 1
• If symptoms persist beyond this period, further investigation for underlying causes should be considered 4
• Persistent or recurrent mesenteric lymphadenitis may indicate an underlying condition such as inflammatory bowel disease, tuberculosis, or other infectious or autoimmune disorders 4, 6

Pitfalls and Caveats

• Mesenteric lymphadenitis can mimic acute appendicitis, leading to unnecessary surgical interventions if not properly diagnosed 1
• It is important to rule out other causes of mesenteric lymphadenopathy, including infectious diseases (tuberculosis), inflammatory bowel disease, and malignancy 4, 3, 6
• In cases where the diagnosis remains uncertain despite imaging studies, a multidisciplinary approach involving gastroenterologists, infectious disease specialists, and surgeons may be beneficial 5