Mesenteric adenitis

What is mesenteric adenitis?

Mesenteric adenitis means swollen (inflamed) lymph glands in the tummy (abdomen), which cause tummy pain. It is not usually serious and usually gets better without treatment.

Mesenteric adenitis is a fairly common cause of tummy 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.

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 tummy, next to the gut (intestine), that swell during a bout of mesenteric adenitis. (See the separate leaflet called Swollen lymph glands for more about lymph glands.)

What are the symptoms of mesenteric adenitis?

Mesenteric adenitis is usually a mild condition which causes temporary pain in the tummy (abdominal pain), usually in children.

The symptoms of mesenteric adenitis often start following a sore throat or flu-like symptoms.

The main symptoms of mesenteric adenitis are:

• A sore throat or symptoms of a cold before the tummy pain started.

• Pain in the tummy. The pain is usually in the middle of your tummy (near your belly button). The pain may be in the lower right-hand side of the tummy (called the right iliac fossa).

• High temperature (fever) and feeling generally unwell.

• Feeling sick (nausea) and/or diarrhoea.

What causes mesenteric adenitis?

The most common cause of mesenteric lymphadenitis is a viral infection, such as gastroenteritis. A germ (infection) triggers the inflammation and swelling in the lymph glands.

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).

It can also be caused by inflammatory bowel disease (IBD).

How common is mesenteric adenitis?

Mesenteric adenitis is a fairly common cause of tummy (abdominal) pain in children aged under 16 years. It is much less common in adults.

How is mesenteric adenitis diagnosed?

Usually, it is diagnosed from your symptoms, your medical history, 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.

Sometimes it is difficult to make a diagnosis or to rule out other causes of tummy pain, such as appendicitis.

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). These tests may show features that suggest the diagnosis of mesenteric adenitis, or they may help to rule out other conditions that cause similar symptoms (such as appendicitis).

If the diagnosis is still not clear and there is a risk of you having a more serious condition such as acute appendicitis then you may need an operation to make sure. This is usually keyhole surgery (laparoscopy) but sometimes a more extensive operation (laparotomy) is needed to check for any serious condition.

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 the separate leaflet called Ectopic pregnancy for more details.

What is the treatment for mesenteric adenitis?

Usually, no treatment is needed for mesenteric adenitis other than painkillers (if needed) and plenty of rest. 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 your tummy to 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?

The symptoms of mesenteric adenitis usually improve within a few days, and will almost always clear up completely within about two weeks. Rarely, if infection with a germ (bacterium) is the cause, the condition can become serious if left untreated.