Mesenteric lymphadenitis

Background

• Inflammation of mesenteric lymph nodes
• Frequently mistaken for appendicitis

Clinical Features

• RLQ pain, frequently confused with appendicitis

Differential Diagnosis

RLQ Pain

• GI
  • Appendicitis
    • Perforated appendicitis
  • Peritonitis
  • Crohn's disease (terminal ileitis)
  • Diverticulitis (cecal, Asian patients)
  • Inguinal hernia
  • Mesenteric ischemia
  • Ischemic colitis
  • Meckel's diverticulum
  • Neutropenic enterocolitis (typhlitis)
• GU
  • Ectopic
  • Endometriosis
  • Kidney stone
  • Mittelschmerz
  • Ovarian cyst
  • Ovarian torsion
  • PID
  • Pyelonephritis
• Other
  • Abdominal aortic aneurysm
  • Epiploic appendagitis
  • Mesenteric lymphadenitis
  • Herpes zoster
  • Psoas abscess
  • Testicular torsion

Evaluation

• Frequently found on abdominal CT (when ruling out appendicitis)

Management

Uncomplicated/mild

• Supportive care (do NOT require antibiotics)

Mod-severely ill

• Cover for Yersinia
  • • Severe disease may warrant ciprofloxacin and/or TMP-SMX

Disposition

Normally discharged home, unless:

• Significant volume depletion
• Significant electrolyte imbalance
• Sepsis