Mesenteric adenitis is generally a mild condition which causes temporary pain in the tummy (abdomen), 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 swollen (inflamed) lymph glands in the tummy (abdomen), which cause abdominal 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. It is much less common in adults.
The name comes from mesentery, which is the part of the abdomen where the glands are located. 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 body's defence (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 gut (intestine), that swell during a bout of mesenteric adenitis. (See separate leaflet called Swollen Lymph Glands for more about lymph glands.)
What causes mesenteric adenitis?
Probably, a germ (infection) 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. The inflamed glands then cause pain, tenderness and a high temperature (fever).
What are the symptoms of mesenteric adenitis?
The symptoms are:
- Pain in the tummy (abdomen). The pain is usually in the middle of your tummy (near your belly button). The pain may be in lower right-hand side of the tummy (called the right iliac fossa).
- High temperature (fever) and feeling generally unwell.
- You may possibly feel sick (nausea) and/or have 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 tummy (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.
If the diagnosis is not clear, your doctor may suggest:
- Wait and see, with another check by your doctor a few hours later to see if the 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 a definite diagnosis of 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 suggest the diagnosis of mesenteric adenitis.
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. See also the separate leaflet on Ectopic Pregnancy.
What is the treatment?
Usually, no treatment is necessary other than painkillers (if needed). If infection with a germ (a bacterial infection) is suspected, you may be given antibiotic medication, but this is uncommon.
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 or becoming more unwell mean you should seek further advice straightaway.
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 tummy (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 tummy.
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 for swollen glands, but to make sure other important problems, like appendicitis, are not missed.
What is the outlook (prognosis)?
The symptoms usually improve within a few days, and will almost always clear up completely within two weeks. Rarely, if infection with a germ (a bacterial infection) is the cause, the condition can become serious if left untreated.
Dr Tim Kenny
Dr Colin Tidy
Dr Hannah Gronow