pediatric final

Overview Mesenteric adenitis (mesenteric lymphadenitis) is an inflammatory enlargement of mesenteric lymph nodes, most often presenting in children with acute abdominal pain that mimics appendicitis. It is usually self-limited and commonly associated with viral or bacterial gastrointestinal infections (Nelson22e, Part XVI; Part XV). Key Definition Mesenteric adenitis = inflammation and enlargement of mesenteric lymph nodes, typically in the right lower quadrant, often causing pseudoappendicitis (Nelson22e, Part XVI, Chap 387). Etiology & Pathophysiology Usually triggered by infection of the terminal ileum with reactive lymphoid hyperplasia Common pathogens: Yersinia enterocolitica / Y. pseudotuberculosis 🦠 Campylobacter Adenovirus Viral gastroenteritis COVID-19–associated GI disease (Nelson22e, Part XVI; Part XV) Pathology: enlarged mesenteric nodes with a normal appendix, especially in Yersinia infection (Nelson22e, Part XV). Clinical Features & Examination 🩺 Fever Abdominal pain (often right lower quadrant) Tenderness mimicking appendicitis ± Diarrhea or preceding upper respiratory symptoms Older children and adolescents are more commonly affected (Nelson22e, Part XVI) 🩺 Bedside clue: Abdominal pain with imaging showing lymphadenopathy without appendiceal inflammation. Investigations & Interpretation 📊 1) Ultrasound (preferred): Enlarged mesenteric lymph nodes Normal appendix 2) CT scan if ultrasound is nondiagnostic: Lymphadenopathy ± terminal ileal wall thickening 3) Labs: Mild leukocytosis may be present (Nelson22e, Part XVI; Part XV) Management Principles 🔹 Supportive Care (MOST cases) Analgesia Hydration Observation ➡️ No antibiotics needed for uncomplicated mesenteric adenitis (Nelson22e, Part XV). 🔹 When to Treat with Antibiotics Antimicrobial therapy is NOT routinely required, except in specific situations: 1) Uncomplicated Yersinia mesenteric lymphadenitis Self-limited No antibiotics required (Nelson22e, Part XV) 2) Culture-confirmed or severe Yersinia infection Especially bacteremia or systemic disease Treat with: Third-generation cephalosporin ± aminoglycoside TMP-SMX Fluoroquinolone Chloramphenicol (Nelson22e, Part XV) Pearls & Clinical Relevance 💡 Mesenteric adenitis is a common cause of pseudoappendicitis in children. Most cases resolve without antibiotics. Yersinia infection is the classic bacterial association, especially in older children. Imaging is key to avoiding unnecessary appendectomy. Always reassess—true appendicitis remains the most important differential (Nelson22e, Part XVI).

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