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Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children

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Abstract

Mesenteric lymphadenitis (ML) is considered as one of the most common alternative diagnosis in a child with suspected acute appendicitis (AA). In this retrospective study, patients diagnosed with ML (n = 99) were compared in terms of demographic, clinical, and laboratory findings to patients diagnosed with AA (n = 102). This comparison was applied for both lymph nodes smaller and larger than 10 mm. When compared to patients with AA, patients with ML had significantly longer duration of symptoms prior to emergency department (ED) presentation (2.4 ± 2.6 vs 1.4 ± 1.4 days, P = 0.002) and multiple ED presentations (1.3 ± 0.7 vs 1.05 ± 0.3, P < 0.001) and had longer duration of stay in the ED (9.2 ± 5.9 vs 5.2 ± 4 h, P < 0.001), respectively. They also had significantly lower WBC (10.16 ± 4.7 × 103/dl vs 15.8 ± 4.4 × 103/dl, P < 0.001) with lymphocyte predominance (24.6 ± 14 vs 13 ± 8.7%, P < 0.001) and lower CRP levels (0.48 vs 1.6 mg/dl). Migration of pain (28 vs 7%), vomiting (62 vs 34%), and classic abdominal findings of AA (72 vs 20%) were all significantly more common for children with AA. When comparing lymph node size, no significant difference was found between those presenting with small and large nodes.

Conclusion: This study highlights multiple clinical and laboratory findings that differentiate ML and AA. Moreover, the absence of any difference with regard to the lymph nodes size might suggest that lymph nodes enlargement is a non-specific finding.

What is Known :

• Mesenteric lymphadenitis is a very common diagnosis in children with suspected acute appendicitis.

• Despite its prevalence, only few studies addressed the clinical characteristics of this clinical entity and their comparison with acute appendicitis.

What is New:

• Mesenteric lymphadenitis and acute appendicitis could be differentiated by multiple clinical and laboratory parameters.

• No significant difference was found between those presenting with small and large lymph nodes.

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Abbreviations

AA:

Acute appendicitis

CT:

Computerized tomography

ED:

Emergency department

ML:

Mesenteric lymphadenitis

RLQ:

Right lower quadrant

URTI:

Upper respiratory tract infection

US:

Ultrasound

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Authors and Affiliations

  1. Department of Pediatrics, Hadassah Medical Center, Ein Kerem, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel

    Itai Gross & Yael Siedner-Weintraub

  2. Faculty of Medicine, Hebrew University, Ein Kerem, Jerusalem, Israel

    Shir Stibbe

  3. Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel

    David Rekhtman & Saar Hashavya

  4. Department of General Surgery, Hadassah and Hebrew University Hospital, Jerusalem, Israel

    Daniel Weiss

  5. Medical Imaging, Hadassah and Hebrew University Hospital, Jerusalem, Israel

    Natalia Simanovsky

  6. Pediatric Surgery, Hadassah and Hebrew University Hospital, Jerusalem, Israel

    Dan Arbell

Authors
  1. Itai Gross
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  2. Yael Siedner-Weintraub
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  3. Shir Stibbe
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  4. David Rekhtman
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  5. Daniel Weiss
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  6. Natalia Simanovsky
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  7. Dan Arbell
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  8. Saar Hashavya
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Correspondence to Itai Gross.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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All authors have indicated they have no financial relationships relevant to this article to disclose.

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Communicated by Jaan Toelen

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Gross, I., Siedner-Weintraub, Y., Stibbe, S. et al. Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children. Eur J Pediatr 176, 199–205 (2017). https://doi.org/10.1007/s00431-016-2822-7

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  • DOI: https://doi.org/10.1007/s00431-016-2822-7

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