From the Research
Mesenteric adenitis is a self-limiting inflammatory condition affecting the mesenteric lymph nodes, typically occurring in children, adolescents, and young adults, and is characterized by symptoms mimicking appendicitis or intussusception, but resolves completely without residuals within 2-4 weeks with supportive care. The condition is often preceded by a viral or bacterial infection in the gastrointestinal tract or upper respiratory system, and its symptoms include abdominal pain, usually in the right lower quadrant, fever, nausea, vomiting, and sometimes diarrhea. Key differences from appendicitis include more diffuse and moving abdominal pain. Management of mesenteric adenitis focuses on symptom relief with hydration, pain medication such as acetaminophen or ibuprofen, and rest, as outlined in a study published in 2017 1. No antibiotics are typically needed unless there's evidence of bacterial infection. While concerning due to its similarity to appendicitis, mesenteric adenitis is benign and doesn't require surgical intervention, as the inflammation occurs because lymph nodes are responding appropriately to infection elsewhere in the body, enlarging as they filter pathogens and activate immune responses. Some studies have investigated the appearance of mesenteric adenitis on computed tomography (CT) scans, noting that it can be identified by clustered, enlarged mesenteric lymph nodes with a normal appendix, and may be associated with ileitis or ileocolitis 2. However, the most recent and highest quality evidence prioritizes supportive care and reassurance, as the condition is self-limiting and resolves without specific treatment within a few weeks 1. In evaluating patients with right lower quadrant pain, it's essential to consider mesenteric adenitis as a differential diagnosis, alongside other conditions such as appendicitis, Meckel diverticulum, and inflammatory bowel disease 3. Given the potential for mesenteric adenitis to mimic more severe conditions, a thorough diagnostic approach, including ultrasonography, is crucial to establish an accurate diagnosis and provide appropriate management. The primary goal of treatment should be to alleviate symptoms and provide supportive care, rather than pursuing unnecessary surgical or antibiotic interventions, as supported by the most recent evidence 1.