Mesenteric adenitis is usually a mild condition which causes temporary pain in the abdomen (tummy), usually in children. It usually clears up without treatment. Sometimes mesenteric adenitis is difficult to diagnose, and it may be difficult to distinguish it from other causes of abdominal pain such as appendicitis.
What is mesenteric adenitis?
Mesenteric adenitis means inflamed (swollen) lymph glands in the abdomen, which cause abdominal pain (tummy pain). It is not usually serious and usually gets better without treatment. Mesenteric adenitis is a fairly common cause of abdominal pain in children aged under 16 years, but is less common in adults.
The name comes from mesentery, which is the part of the abdomen where the glands are located, and adenitis which means inflamed lymph glands. It is sometimes called mesenteric lymphadenitis.
What are lymph glands?
Lymph glands (also called lymph nodes) occur throughout the body. They are normally pea-sized. They are a major part of the immune system. During an infection, lymph glands swell and become painful while the immune system fights off infecting germs. They go back to normal after the infection is over.
Most people are familiar with lymph glands in the neck that can swell when you have a sore throat or tonsillitis. In a similar way, it is the lymph glands in the abdomen, next to the intestines, that swell during a bout of mesenteric adenitis. (See separate leaflet called 'Lymph Glands Swollen' for more about lymph glands.)
What causes mesenteric adenitis?
Probably, an infection (germ) is what triggers the inflammation and swelling in the lymph glands. Most cases are probably due to a viral infection. Less often, it may be a bacterial infection that is the cause - for example, a bacterial infection in the intestine (gut). The inflamed glands then cause pain, tenderness and a high temperature.
What are the symptoms of mesenteric adenitis?
The symptoms are:
- Pain in the abdomen (tummy). The pain is usually located either in the centre of the abdomen, or in the lower right-hand side of the abdomen (known to doctors as the right iliac fossa).
- Fever (high temperature) and feeling generally unwell.
- You may possibly have some nausea and/or diarrhoea.
- You may have had a sore throat, or symptoms of a cold, before the abdominal pain started.
How is mesenteric adenitis diagnosed?
Usually, it is diagnosed from your symptoms and a doctor's examination. If you have (or your child has) typical symptoms and there are no signs of anything else causing the pain, then your doctor may think that mesenteric adenitis is likely. It is difficult to prove the diagnosis, because the glands are deep in the abdomen and cannot be seen or felt. So the diagnosis often involves excluding other problems which could cause this type of pain, and then making a presumed diagnosis of mesenteric adenitis.
Sometimes it is difficult to make a diagnosis or to rule out other problems. For example, mesenteric adenitis can imitate other causes of abdominal pain, such as appendicitis or ectopic pregnancy. (See separate leaflets called 'Appendicitis' and 'Ectopic Pregnancy' for details on these conditions.)
If the diagnosis is not clear, your doctor may suggest:
- A period of observation (wait and see), with a review after a few hours to see if symptoms have changed.
- A second opinion - for example, a referral to hospital for a surgeon's opinion.
- Tests to look for other conditions (see below).
Are any tests needed?
There is no specific test that proves conclusively that you have mesenteric adenitis. However, some tests may help in diagnosing other conditions which could be causing the pain. For example, blood tests, a urine test for infection, or scans (ultrasound or CT scan). Sometimes, the features on a scan are typical of swollen glands which may point more to the diagnosis of mesenteric adenitis than to other causes of pain such as appendicitis.
Note: if there is any possibility that you could be pregnant, a pregnancy test is essential. This is because the serious condition called ectopic pregnancy, which can occur in early pregnancy, may cause symptoms similar to mesenteric adenitis.
When might an operation be needed?
In some cases, problems such as appendicitis or ectopic pregnancy cannot be totally ruled out, even after tests. If so, you may need an operation to look inside the abdomen and check for any suspected problem. Sometimes this can be done as keyhole surgery (laparoscopy), where a thin fibre-optic telescope is used to look inside the abdomen.
If you have an operation or laparoscopy, then the inflamed glands may actually be seen. However, the purpose of the operation is not to look at the glands, but to ensure that other important problems are not missed.
What is the treatment?
Usually, no treatment is necessary other than painkillers (if needed). If a bacterial infection is suspected, you may be given antibiotics, but this the exception rather than the rule.
Your doctor will advise about the symptoms to look out for which suggest that you should be seen urgently for review. For example, increasing pain, becoming more unwell or pain lasting longer than is usual for mesenteric adenitis should prompt you to seek further advice.
What is the outlook?
The symptoms usually improve within a few days, and will almost always clear up completely within two weeks. Rarely, if a bacterial infection is the cause, the condition can become serious if left untreated.
Further reading & references
- Humes DJ, Simpson J; Acute appendicitis. BMJ. 2006 Sep 9;333(7567):530-4.
- Bonheur JL; Mesenteric Lymphadenitis. Medscape, Aug 2009
- Burke B et al; Mesenteric Adenitis Imaging, Medscape, May 2011
- Davenport M; Acute abdominal pain in children. BMJ. 1996 Feb 24;312(7029):498-501.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Tim Kenny