About the disease
Mesenteritis (mesenteric lymphadenitis, mesenteritis) is a disease associated with inflammation of the lymph nodes located in the mesentery of the small intestine. Although only a few have heard of it, doctors do not consider it a rare disease. According to some reports, about 8 - 9% of children who are admitted to the surgical department with suspected appendicitis have signs of inflammation of the mesenteric lymph nodes. Boys usually predominate among the sick, although some studies refute this (N.L. Kushch 1984), and the age of patients ranges from 5 to 13 years.
Mezadenitis is most typical for children and young people of thin build. In the first 10 years of a child's life, this pathology is more common than appendicitis.
The autumn-spring seasonality of the disease is noted. Usually, the ailment makes itself felt at the beginning of the school year and during the height of respiratory infections.
A bit of anatomy
The mesentery is a thin fold, which is a doubled sheet of the peritoneum, which connects all intestinal loops and ensures their secure attachment to the back wall of the abdominal cavity. Inside the fold are blood and lymph vessels, nerve fibers.
Its numerous mesenteric (mesenteric) lymph nodes perform various functions: they form immunity, eliminate pathological particles and cancer cells, and some blood cells grow and differentiate in them. The total number of mesenteric lymph nodes varies within 400 - 600, and when inflammation occurs in the abdominal cavity, they are the first to react to pathology.
Why does the disease occur
Lymphatic tissue is a kind of barrier that prevents the spread of infectious agents in the body. Infectious agents can enter the blood and lymph flow from various organs.
The causes of the disease are diverse, so it is not always possible to identify the main one. But in any case, at the heart of mesenteric adenitis is the ingress of an infectious agent into the mesenteric lymph nodes and the development of inflammation in them against the background of reduced immunity.
Types of pathogens of mesenteritis:
- bacteria.
These microorganisms are the cause of many diseases. Often, diseases such as salmonellosis, yersiniosis, campylobacteriosis, tuberculosis, appendicitis, cholecystitis, Crohn's disease, pancreatitis cause signs of mesenteritis. The development of the disease in a child can be a complication of a severe course of a respiratory disease, the presence of an infectious focus in the organs of the respiratory system.
Even opportunistic bacteria (staphylococcus, E.coli, streptococcus), which normally live in the nasopharynx, gastrointestinal tract, under favorable conditions for them can multiply and cause illness. This fact confirms the connection between the state of the child's immune system and the risk of mesenteric development;
- viruses.
The appearance of signs of mesenteritis often accompanies viral infections of the respiratory, genitourinary system, gastrointestinal tract. Some authors believe that adeno- and herpesvirus infections play a leading role in the onset of the disease in children. An increase in lymph nodes throughout the body, including mesenteric ones, often occurs with cytomegalovirus and enterovirus infection, parainfluenza, infectious mononucleosis.
To date, the question of determining the main causes of mesenteric adenitis remains open. But all researchers assign a significant role to the immunological reactivity of the child's body.
In rare cases, an increase in the mesenteric lymph nodes occurs in cancer, parasitic, fungal and autoimmune diseases.
Classification
Experts distinguish several types of mesenteric adenitis:
- nonspecific, which develops when an infectious agent enters the lymph nodes from the primary focus of inflammation (this type of mesenteritis, in turn, is divided into simple and purulent);
- specific mesenteric adenitis in tuberculosis, syphilis, yersiniosis and other pathologies.
By the nature of the course, the ailment is divided into:
- acute mesenteric adenitis;
- chronic.
How is mesenteric infection manifested in children?
Features of the clinical picture of acute nonspecific mesenteric adenitis
- initial manifestations.
Children are characterized by the appearance of a period masking the disease, when the baby develops conjunctivitis, signs of respiratory infections, and the body temperature rises to 38 degrees. This period can last from 12 hours to 2 - 3 days;
- pain in the abdomen.
The baby's condition is gradually deteriorating and pain syndrome comes first in the complaints of the baby. The child complains of aching pain in the navel, to the right and below it, then the symptom changes somewhat, it becomes cramping. These manifestations are explained by irritation of the nerve endings located in the mesentery and peritoneum, an intense contraction of the intestinal loops.
When the baby tries to change the position of the body, make active movements, the pain syndrome increases. The child assumes a forced lying position on his side, thus reducing the pressure in the area of the lymph nodes;
- dyspepsia.
About half of patients with mesenteric adenitis report the appearance of nausea, and 30% complain of vomiting, which is associated with reflex irritation of the peritoneal sheets. In addition, babies often have such manifestations as flatulence, stools become more frequent, or vice versa, constipation occurs;
- fever.
The height of clinical manifestations proceeds with a sharp increase in body temperature up to 38 - 39 degrees, which does not easily go astray and soon reappears. Fever is usually accompanied by tachycardia (increased heart rate) and tachypnea (increased respiratory rate);
- intoxication syndrome.
General manifestations with inflammation of the mesenteric lymph nodes are significantly pronounced. The child becomes weak, lethargic, capricious, his sleep and appetite disappear. Every day, the symptoms of the disease only intensify, and the severity of the condition of the crumbs is beyond doubt.
The development of purulent mesenteric adenitis is characterized by more pronounced symptoms of intoxication, a significant deterioration in the baby's condition, but the signs of pain in this case tend to subside.
Chronic nonspecific mesenteric adenitis in a child
With this form of the disease, there are no clear signs characteristic of the acute form of mesenteritis. A baby can complain of pain in the abdomen for a long time, which is more pronounced with physical activity. The appearance of dyspeptic disorders, symptoms of intoxication, a slight increase in body temperature during exacerbations of the disease is possible, but these manifestations are temporary.
Specific mesenteric lymphadenitis
In most cases, children are diagnosed with non-specific inflammation, cases of mesenteritis caused by certain pathogens are much less common. With this form, the clinical picture is somewhat different. So, with tuberculous mesenteric disease, the manifestations of the disease develop gradually, the pain syndrome does not have a clear localization, the baby notes short-term soreness in the abdomen. Symptoms of intoxication, weakness and lethargy, a prolonged increase in body temperature to subfebrile numbers come to the fore, the skin may become pale with a greenish tint.
Diagnostics
The diagnosis of mesenteric adenitis sometimes causes difficulties, the ailment can be disguised as other diseases (appendicitis, renal colic, ovarian apoplexy, and others). Therefore, a child with abdominal pain syndrome needs to undergo a complete examination, which includes:
History taking, physical examination
When talking with parents, the doctor specifies how the disease developed, notes the presence of complaints characteristic of this ailment, specific manifestations.
In the event of severe pain in the abdomen, the baby must be consulted by a surgeon.
Examining the baby, the doctor palpates the abdomen, at the same time determining the symptoms specific for mesentericitis (McFadden, Klein, Sternberg). The main symptom indicating inflammation of the mesenteric lymph nodes is a combination of pain in the center of the abdomen and its intensification when probing the area of the root of the mesentery of the small intestine.
With the development of complications of mesenteric adenitis, its abscess formation, irritation of the peritoneum occurs with symptoms of tension of the abdominal muscles, significant pain syndrome, which increases when the hand is torn off during palpation of the abdomen;
Laboratory data
The main sign of inflammation is changes in the clinical analysis of blood - an increase in the number of leukocytes and an increase in ESR. The viral nature of the disease may be indicated by lymphocytosis, a shift in the formula to the right. If you suspect the presence in the body of a specific causative agent of mesenteric infection - mycobacterium tuberculosis, it is possible to conduct a Mantoux test, diaskintest.
In order to accurately identify the causative agent of the disease, it is possible to carry out serological reactions. Performing blood cultures for sterility takes time, so if the condition of the crumbs worsens, empiric antibiotic therapy is performed (aimed at the most common pathogens of the disease);
Instrumental methods
Ultrasound is an important and easy-to-follow method for diagnosing various diseases. With the help of ultrasound, "packets" of enlarged mesenteric lymph nodes, abscesses, flatulence are detected.
An increase in mesenteric lymph nodes can also be found in appendicitis in a child, but their number is much less than in mesenteric disease.
With the help of the modern method of MRI examination, the doctor can accurately determine which groups of lymph nodes are enlarged, their size and condition. This diagnostic method is very informative and most likely helps to make a correct diagnosis.
Laparoscopic examination (the introduction of a special probe with a camera into the abdominal cavity) for diagnostic purposes is rarely performed, if other methods are ineffective. It is used to verify the diagnosis, exclude other pathologies of it and take a piece of tissue from the lymph node for histological examination.
Timely, correctly carried out diagnosis of mesenteritis in a child will help to distinguish it from other diseases (primarily from appendicitis), and will allow the correct treatment to begin on time. If the mesenteric adenitis remains unrecognized for a long time, the risk of developing purulent complications, the formation of an abscess, an abscess breakthrough into the abdominal cavity with the onset of peritonitis, sepsis increases.
Treatment
Treatment methods differ depending on the type of ailment. With simple nonspecific mesenteric adenitis, conservative treatment is possible, but it should be carried out in a hospital setting, under constant medical supervision. The baby is recommended to stay in bed, a course of antibacterial or antiviral drugs is carried out, depending on the probable pathogen, anesthetic and infusion therapy is prescribed. Good results in this type of disease are brought by the use of physiotherapeutic procedures (magnetotherapy, UHF and others).
If the disease proceeds with signs of suppuration of the lymph node, surgical treatment may be needed. Specific tuberculous mesenteric adenitis requires complex treatment, which includes anti-tuberculosis drugs, vitamins, and immunomodulators. Treatment in this case is prescribed by a phthisiatrician.
In order to prevent the disease and prevent recurrent episodes of the disease, it is worth monitoring the health of the baby, sanitizing the foci of infection in time, paying attention to proper nutrition, daily routine and sufficient physical activity. These simple methods will help strengthen your baby's immunity.
Conclusions
A child's abdominal pain can indicate various diseases, some of which can lead to the development of dangerous complications. There are situations when the mesenteric lymph nodes become inflamed, and the baby's condition deteriorates sharply. Parents need to understand that soreness in the abdominal cavity is a dangerous symptom and should not postpone going to the doctor if it occurs.
