How to manage Mesenteric Adenitis? – Dr. Nagaraj B. Puttaswamy

Mesentery is an organ which houses numerous blood vessels which is probably the bases of the whole of the small and the large intestine. Mesentery is a fan shaped structure because it is connecting into the small intestine and it has very close connected base and it will give blood supply and take the venous supply and also multiple lymphatic supply back to the system In between there are multiple lymph nodes in the system in the Mysentery which is normally present. So Mesenteric lymphadenitis is a condition where the lymph nodes have become significantly bigger or for whatever reason it is .So lymphadenitis or adenitis is because of an infection or a cancerous condition. Adenitis which is is seen in a CT or an MRI is usually picked up beyond 1 cm, that is the size of the lymph nodes is beyond 1 cm. the commonest lymphadenitis we try and see is related to the infection of the small intestine or the appendix. A patient who is suffering from recurrent appendicitis suffer from pain abdomen, then an ultrasound or CT scan is done, appendix is inflamed with a few enlarged lymph nodes in the mesentery. This is the diagnosis we get and we do an appendicectomy laparoscopically and we pick up one or two lymph nodes from the mesentery and send it for histopathological diagnosis. A nonspecific infection can cause significant amount of, lymphadenitis which has severe pain, fever, discomfort, vomiting and all these presentations. The patient has got pain abdomen which is changing in position, it can be on the right side or the left side while checking in the same patient. This is because mesentery is not a structure which stays in one place. Even when the patient turns to the other side, the mesentery can shift there and if I try to feel here because the lymph nodes, are there in the mesentery, the pain would be more there on the other side. This is the most typical clinical finding that you find in an acutely suppurative mesenteric lymphadenitis. So it has to be treated very aggressively with painkillers and antibiotics andprobably the patient has to be in empty stomach. If the patient doesn’t t show improvement the patient has to be subjected to surgical intervention particularly laparoscopic. Mesenteric lymphadenitis is a condition related to infection and malignancy. Tubercular lymphadenitis may be see. Lymphadenitis related to Crohn’s may be seen. Cancerous condition may be seen, wither a Hodgkins lymphoma or a non Hodgkins lymphoma. Lymph nodes in the mesentery maybe seen secondary to the cancer of the small intestine particularly adenocarcinoma of the small intestine or the cancer of the large intestine also particularly adenocarcinoma of the large intestine can also cause lymph node enlargement in the mesentery.