Clinico-Radiological Profile of Abdominal Pain in Children Admitted in a Tertiary Care Centre-A Retrospective Cohort Study

Background and Aim: Mesenteric lymphadenitis in pediatric population usually presents with abdominal pain mimicking appendicitis mounting a challenging task for physicians to diagnose. It is a self-limiting inflammatory process and resolves spontaneously. In addition to clinical features, ultrasonography is the primary diagnostic modality. We aimed to evaluate the clinico-radiological characteristics of mesenteric adenitis in patients presenting with abdominal pain. Materials and Methods: A total of 108 patients attending paediatric out-patient and paediatric surgery clinic in Saveetha Medical College and Hospital, Chennai, between January 2018 and December 2020 with abdominal pain for several aetiologies were included in this study. The clinical presentation, laboratory parameters and the ultrasonographic findings were noted. Data summarized as numbers, percentages and Mean ± Standard Deviation (SD). Results: Peak prevalence was found to be at around 8 [range 6-10] years. Clinically, 58.3% had fever, 40.7% had dysuria and 36.1% had diarrhoea. Laboratory parameters were non-specific for this condition. Majority of the enlarged lymph nodes were found in the right lower quadrant (81.5%) followed by (10.2%) in the para-umbilical region and (8.3%) in left lower quadrant. Conclusions: Mesenteric lymphadenitis as an individual clinical entity is a very challenging task for the paediatricians to evaluate and diagnose due to several possible variations in the clinical presentation. Although mesenteric lymphadenitis is usually a self limiting entity, a cohort of children warrant medical interventions.

Intermittent intestinal intussusception in patients with mesenteric lymphadenitis in the ileocecal angle

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

Aetiological Outcome of Mesenteric Lymphadenopathy and Pain Abdomen in Paediatric Population at a Tertiary Care Hospital (MRIMSHyderabad) - A Hospital Based Prospective Observational Study

BACKGROUND Abdominal pain is a common disorder in children and adolescents worldwide with prevalence rate ranging from 20 - 25 % in school-going children in India. It is a frustrating concern to the child, parents and the physician. Even though abdominal pain is one of the most common complaints in children, it poses a diagnostic challenge owing to the variety of underlying causes. The purpose of this study was to evaluate the aetiology of abdominal pain associated with significant mesenteric lymphadenopathy in a paediatric population. METHODS This is a hospital based prospective, observational study done in Department of Paediatrics, Malla Reddy Institute of Medical Sciences (MRIMS), Hyderabad. RESULTS Out of the 65 children studied, 30.8 % were of 5 - 8 years age group, 36.9 % were 9 - 12 years age group and 32.3 % were 13 - 15 years age group. In our study, we found 50.8 % were boys and 49.2 % were girls. 20 % of them were having fever, 16.9 % were having cough, 16.9 % were having diarrhoea, 13.8 % were having sore throat, 16.9 % dysuria, and 15.4 % were having constipation. All patients in our study group underwent ultrasound of abdomen. All cases were having significant mesenteric lymphadenopathy (more than 5 mm in short axis with three or more number of lymph nodes). In 53.8 % cases, etiological agent for the mesenteric lymphadenopathy was not proved with our investigations. In the remaining 46.2 % of children, cause of mesenteric lymphadenopathy was proved and 38.5 % were bacterial infections, 6.2 % were viral infections and 1.5 % were parasitic infections. CONCLUSIONS It is important to recognise mesenteric lymphadenitis as a clinical entity in paediatric cases presenting with abdominal pain. They should be evaluated for an etiological agent and if no proven source of infection and etiological agent is found, it can be considered as functional abdominal pain. If we are able to get a proper etiological diagnosis in these cases, we could treat them and we could make huge difference in terms of quality of life. KEYWORDS Abdominal Pain, Mesenteric Lymphadenitis, Ultrasound, Significant Mesenteric Lymphadenopathy

Mesenteric Lymphadenopathy in Children with Chronic Abdominal Pain - A Single Center Retrospective Case Control Study from a Tertiary Care Center in Puducherry

BACKGROUND Mesenteric lymphadenitis (MLN) is found commonly associated with children having chronic abdominal pain, but its significance is rarely mentioned in literature. Mesenteric lymphadenitis is the inflammation of the mesenteric lymph nodes that drain the gastrointestinal tract. The present study was undertaken to assess the prevalence and significance of mesenteric lymphadenopathy among children with chronic abdominal pain (CAP). METHODS This is a single center retrospective case control study conducted in the department of paediatrics of a private medical college in Puducherry. Data was obtained from the records over a period of past 24 months. Cases were defined as 5 - 15 years aged children presenting with chronic abdominal pain. Controls were defined as 5 - 15 years aged children who were subjected to abdominal ultrasonography for reasons other than abdominal pain. Records over past 24 months were studied and for uniformity of analysis, a total of 100 children aged 5 - 15 years, were included in both the groups. Data from the case records was analysed retrospectively to calculate the prevalence of mesenteric lymphadenitis in both the groups. RESULTS Chronic abdominal pain was almost equal in both sexes with a male : female ratio of 0.9 : 1. In our study, the incidence of significant MLN among children with chronic abdominal pain was 89 % [n = 89, out of 100 cases] and was 26 % among controls [n = 26, out of 100 controls]. CONCLUSIONS This study showed that MLN is one of the most common findings in children with CAP with higher incidence among cases than controls and is statistically significant. Abdominal ultrasonography is a useful tool in the evaluation of CAP to rule out organic causes. KEYWORDS Chronic Abdominal Pain (CAP), American Academy of Paediatrics (AAP), Mesenteric Lymphadenopathy [MLN], Recurrent Abdominal Pain (RAP)

Correlation between sonological and clinical profile of mesenteric lymphadenitis among children in a tertiary care hospital of central Kerala

Background: For abdominal pain in children, imaging is routinely applied to make a possible diagnosis both in the outpatient and in the emergency department. Though the diagnosis of mesenteric lymphadenitis is made often these days, the significance of the size and number is still ambiguous and most studies consider mesenteric lymphadenitis is defined as three or more lymph nodes that are each 5 mm or greater in the short axis.Methods: Cross-sectional study was conducted in a tertiary hospital in central Kerala and the study tool included a detailed structured questionnaire.Results: Our study included 115 children with pain in the abdomen. 69 were found to have mesenteric lymphadenitis. Younger age group, fever as a symptom and acute infective gastroenteritis are statistically significantly associated with mesenteric lymphadenitis.Conclusions: In our study, acute infective gastroenteritis was the most common cause to be associated with mesenteric lymphadenitis which was. The incidence of mesenteric lymphadenitis was found to be more in children below 5 years.

Mesenteric lymphadenitis; a common diagnostic mimic to acute appendicitis. With radiology it is no more a diagnosis of exclusion, laparoscopy or surgery

Mesenteric lymphadenitis (ML) is an inflammatory response to viral infections, bacterial infections, inflammatory bowel disease, or lymphoma in the ileocecal regions. It is a common diagnostic mimic to acute appendicitis. It is a self-limited inflammatory process that affects mesenteric lymph nodes in the right lower quadrant (RLQ). We present a 15 year-old-girl with low grade fever and RLQ pain. Initial physical examination and laboratory investigations suggested acute appendicitis. However, diagnosis of ML was established by the finding abnormal lymph nodes that are usually: (a) clusters of > 3 tender ones anterior to right psoas muscle or in the small bowel mesentery, (b) > 5 mm in diameter of short axis, and (b) rounded in shape. In addition; the ileal or ileocecal wall is thickened (> 3 mm) over at least 5 cm of the bowel and the appendicular wall is normal and its lumen is patent. In conclusion; this case reports indicates tha with radiology; ML can be differentiated from acute appendicitis and limits the role of invasive laparoscopy or surgery in exclusion of the latter. Keywords: appendicitis, CT, mesenteric lymphadenitis, radiology, US.

Mesenteric Lymphadenitis can Mimic Acute Appendicitis in Children

Abdominal pain in children is one of the most common symptoms that a child experiences in his life, and in most cases, the related causes are benign. But when pain is acute, severe and are concentrated in the lower right part of the abdomen, the surgical causes should be excluded, the most important of which is Acute Appendicitis (AA).

Abdominal Signs and Symptoms of COVID-19 in Children

: COVID-19 is an ongoing pandemic that is not known well. According to our current knowledge, although respiratory manifestations are the most common symptoms of COVID-19, but non-pulmonary manifestations are also commonly reported, such as rashes, appendicitis, volvulus, diverticulitis, and mesenteric lymphadenitis. In this case series, we introduced four children with COVID-19 who presented with gastrointestinal symptoms.