A Timely Diagnosis
My daughter was in Cape Town as a special treat, with my husband, to watch England play Algeria. She’d been to the first England game and is determined to be at all their games, although she confesses a lack of optimism for their staying in the SWC.
She phoned me on Saturday night, very tearful and wanting her mom: a mild tummy ache that began on Thursday had become agonizing pain. I asked Old Spouse to take her temperature regularly and to take her to an emergency doctor if she started vomiting.
By Sunday things were worse and they flew home yesterday at 6am and I had our GP waiting to see her. He diagnosed acute appendicitis and phoned a specialist surgeon to tell him we were on our way. I broke several traffic rules and got to Morningside Clinic in record time.
The surgeon examined her, asked a lot of questions and said he felt almost sure it was appendicitis, but something didn’t seem to ‘fit’ and he wanted to be sure before he scheduled her for theatre. She was sent for a battery of blood tests, scans and xrays. After almost four hours of this business and the endless waiting for results, we were told that she has mesenteric lymphadenitis; which is really not as dreadful as it sounds.
I’m sharing this here, because a careful man took the time to make an accurate diagnosis and prevent unnecessary and very invasive surgery.
Mesenteric lymphadenitis is an inflammation of the lymph nodes on the wall of the mesentery (the covering of the intestines).
If is often a childhood illness, though occasionally seen in adults.
It is a very common cause of abdominal pain in children, mimicking appendicitis, and often difficult to differentiate from appendicitis.
It is estimated that 1 in 5 children diagnosed with appendicitis actually have mesenteric lymphadenitis.
Mesenteric lymphadenitis usually follows viral infection with the common cold, or with infection by Yersinia enterocolitica, Pseudo tuberculosis, Streptococcus viridansor Campylobacter jejuni.
While Streptococcus viridans, Campylobacterand Pseudo tuberculosis infection are common world wide, infection by Yersinia enterocolitica is mostly found in the cold regions of the world, especially in Europe and Australia.
The bugs gain access to the wall of the intestine, and invade the lymph nodes on the covering of the intestines called the mesentery.
The small intestine is frequently more involved, but the large intestines or colon may also be involved.
The lymph nodes become enlarged due to inflammatory process induced by the micro-organisms.
The inflammatory process, coupled with the stretch effect on the wall of the mesentery by the enlarged lymph node cause pain.
Pus may form in severe cases and spread to cause disseminated infection.
Most times though, the infection resolves on it own without the need to do anything.
Signs and Symptoms
The signs and symptoms of mesenteric lymphadenitis are very similar to those caused by appendicitis. They can however be differentiated from those of appendicitis by some subtle differences.
The child is usually not as unwell as one will expect in appendicitis, though in early appendicitis, children may look rather well even though they are symptomatic.
The main signs and symptoms include :
• Abdominal Pain. This is often located in the right lower abdomen or right iliac fossa. It is a colicky abdominal pain which just resolves momentarily without any intervention. The sufferer, usually a child, may be completely pain free between attacks. Characteristically, the pain moves from one spot to the other on the abdomen, in keeping with the movement of the bowel loops in the abdominal cavity.
Asking the child to turn to the left side will demonstrate this shift as the area of pain and tenderness will move along with the bowel to the left.
In appendicitis, the pain may initially start around the umbilicus, then moves over to the right iliac fossa. Once it settles there, it does not move around any longer.
• Preceding Cold or Sore Throat. One thing in the history that gives away the diagnosis of mesenteric lymphadenitis is that of the presence of common cold or sore throat in the days or week before the onset of abdominal pain. There may even still be an on going cough and cold in the child. The neck glands, if examines may still be swollen.
• Fever. There may be an associated fever, running up to 38.5 degrees centigrade.
• Vomiting. Patient may vomit. If they vomited before the onset of pain, appendicitis is most unlikely.
• Diarrhoea. There may be episodes of loose stools, especially where Yersinia infection is involved. Appendicitis could also cause diarrhoea.
• Anorexia. Usually, with mesenteric lymphadenitis, patients are still able to eat and drink. If a patient complains of abdominal pain, and appetite remains good, it is most unlikely he or she has appendicitis.