Lymphadenitis mesenterialis is a disease that occurs in the majority of cases in children. The disease is also referred to by the synonymous terms Maßhoff’s disease and lymphadenitis mesenterica. The main symptom of the disease is swollen and inflamed lymph nodes. The so-called mesenteric lymph nodes are primarily affected.
What is mesenteric lymphadenitis?
Basically, lymphadenitis mesenterialis represents swelling of the lymph nodes. Swelling of the lymph nodes usually occurs as a result of various infections. The so-called illeum is inflamed. In most cases, patients in childhood develop lymphadenitis mesenterialis. Often, no treatment measures are necessary, since lymphadenitis mesenterialis usually heals without therapy. The technical term lymphadenitis stands for an inflammatory condition affecting the lymph nodes. In the majority of cases, this is a consequence of infections. With the inflammation, the lymph node reacts to various types of pathogens. However, there are other potential triggers that may cause lymphadenitis mesenterialis. Possible causes include metabolic disorders, certain types of cancer, and various medications that cause the lymph nodes to swell.
Causes
Lymphadenitis mesenterialis is directly caused by inflammation in the area of the illeum. Infections with various pathogens are usually the cause. Possible germs that may cause nonspecific lymphadenitis mesenterialis are, for example, adenoviruses, the cytomegalovirus or the so-called Epstein-Barr virus. Much less frequently, specific rotaviruses are responsible for the development of lymphadenitis mesenterialis. If it is a specific form of lymphadenitis mesenterialis, the pathogens Yersinia enterocolitica and Yersinia pseudotuberculosis are also possible triggers.
Symptoms, complaints, and signs
Various complaints and signs of disease appear in the setting of lymphadenitis mesenterialis. These often differ slightly from patient to patient and also vary in severity. Basically, mesenteric lymphadenitis shows certain similarities to appendicitis. For this reason, the synonymous term ‘pseudoappendicitis’ was created, which is sometimes used to describe lymphadenitis mesenterialis. Typical symptoms include fever as well as pressure pain in the area of the lower abdomen on the right side. In addition, in some cases, other lymph nodes in other areas of the body are also affected by the swelling. Even the tonsils sometimes swell as part of lymphadenitis mesenterialis. Many symptoms of mesenteric lymphadenitis are similar to those of appendicitis, so that the latter must also be clarified in the differential diagnosis. Special rectal examinations may point relatively clearly to appendicitis, although lymphadenitis mesenterialis is actually present. For example, a typical rectal difference in temperature is found. Especially in the nonspecific form of the disease, the tonsils are often involved.
Diagnosis and course of the disease
Various options are available for the diagnosis of mesenteric lymphadenitis. Their use is based on consideration of the individual symptoms. First, a thorough medical history is important, which the attending physician performs together with the affected patient. Since most of the persons affected are children, the parents or guardians are usually absent. After the patient interview, various clinical examinations take place, on which the physician decides. The responsible pathogens are excreted with the stool and can theoretically be detected in this way. In reality, however, this detection is rarely successful. Diagnosis of lymphadenitis mesenterialis is also possible via the elevated antibody titers. With the help of high-resolution sonographic examinations, the swellings of the lymph nodes can be visualized. Ultrasound examinations of the abdomen also reveal swollen lymph nodes. In addition, a characteristic temperature difference is formed in the rectal region.In terms of differential diagnosis, mesenteric lymphadenitis should be distinguished primarily from Crohn’s disease and appendicitis or inflammation of the appendix.
Complications
In most cases, lymphadenitis mesenterialis results in a fairly high fever. Affected individuals also suffer from symptoms that are relatively similar to influenza. Furthermore, there is also pain in the abdominal area, mainly in the form of pressure pain. The patient’s quality of life is significantly reduced by this pain. Likewise, appendicitis can occur, which is usually also associated with severe pain. Patients also suffer from fatigue and exhaustion. Lymphadenitis mesenterialis also considerably reduces and limits the ability of the affected person to cope with stress. In most cases, mesenteric lymphadenitis does not require direct treatment if it does not lead to further symptoms or complaints. Only in severe cases is medical intervention necessary. Sufferers can also take antibiotics to relieve the symptoms. Further complications usually do not occur. With successful treatment, the symptoms usually disappear completely.
When should you go to the doctor?
People who suffer from fever or a general feeling of illness should see a doctor. If there is a pressure pain in the abdominal region, this indicates an irregularity that should be investigated and treated. Most patients experience irregularities in the entire abdominal region. If there is swelling, enlarged lymphs and tonsils, consultation with a physician is advised. If there is a tightness in the throat, difficulty swallowing or problems with food intake, there is a condition that should be investigated and treated. Inflammations in the body, complaints of the appendix or the digestive tract as well as a decrease in the usual performance are signs of a health impairment. A visit to the doctor is necessary so that an investigation of the cause can take place. If the complaints persist over a longer period of time or increase in intensity, a doctor should be consulted. In case of sweating, loss of appetite, nausea and vomiting, the affected person needs medical care. An increase in pulse rate, disturbances in heart rhythm or sleep disturbances are also indications that should be followed up. If there is a general feeling of malaise, internal weakness or irritability, a visit to the doctor is required. If the affected person can no longer pursue sporting activities as usual or if there are problems in fulfilling everyday obligations, clarification of the complaints is advisable.
Treatment and therapy
Basically, lymphadenitis mesenterialis is a disease that is usually self-limiting. For this reason, therapeutic measures are virtually unnecessary. Intervention is required only in rare exceptional cases. A possible complication in the context of lymphadenitis mesenterialis is, for example, the so-called intussusception. In some cases, surgical intervention is necessary. Patients may be prescribed antibiotics to treat mesenteric lymphadenitis. This is especially the case if the disease is delayed or if the patient is immunosuppressed. Even if therapeutic measures are not used, physical rest for patients is helpful for the course of lymphadenitis mesenterialis.
Outlook and prognosis
The prognosis of lymphadenitis mesenterialis is usually favorable. The administration of drugs kills the pathogens in the organism and subsequently removes them. Within a few days or weeks, the symptoms are alleviated until recovery finally occurs. In a large number of cases, the swelling of the lymph recedes even without therapeutic treatment. A necessary prerequisite for this is a fundamentally stable immune system of the affected person. With a healthy lifestyle, the body’s own defenses may be able to initiate a sufficient healing process on their own. Nevertheless, with medical treatment the overall process is accelerated. With appropriate support, the body’s own defense system can defend itself more quickly against the pathogens and thus bring about an improved course of the disease.Complications can occur in people who have an immature or very weakened immune system. If left untreated, an increase in symptoms is to be expected. Internal strength decreases and the quality of life is significantly reduced. Even with medical care, the healing process is prolonged in these patients. If, in addition, there is an intolerance to the prescribed medicine, a further increase in health irregularities can be expected. Nevertheless, lymphadenitis mesenterialis can be cured despite complications and adversities. In rare cases, surgical intervention is performed as a last resort.
Prevention
Lymphadenitis mesenterialis is usually triggered by certain types of pathogens that cause infection of the organism. As a result, the swellings develop on the lymph nodes. Thus, lymphadenitis mesenterialis can be prevented only to the extent that preventive measures exist for the corresponding disease triggers. Lymphadenitis mesenterialis is self-limiting and does not require treatment in every case. To prevent complications, timely consultation with a physician is recommended to monitor the course of the disease in mostly child patients.
Follow-up care
Lymphadenitis mesenterialis is a disease that in many cases heals without complications. Nevertheless, consistent follow-up is necessary to prevent recurrence of the disease or superinfection with bacteria. Follow-up care is supervised by the attending physician. Especially patients with serious or chronic concomitant diseases, pregnant women, people with weak immune systems, seniors and young children should follow the aftercare instructions of their physician. Then complete remission without relapses can be realized to a great extent. A healthy and mindful lifestyle is essential. This includes, above all, not stressing the body too early through exertion. Sport should only be practiced after consultation with the doctor in order not to expose the cardiovascular system to great strain too early. The immune system also needs some time to regenerate sustainably from the weakening. Drinking enough fluids helps to stabilize the circulation and compensate for fluid loss through sweating in the case of fever. Excessive exposure to cold should be avoided during the follow-up period. Cold feet are just as unfavorable in this context as drafts. Sufficient sleep also helps the body to regenerate. In this context, the life expectancy of the person affected by this disease also usually remains unchanged if it is treated properly.
What you can do yourself
Lymphadenitis mesenterialis usually heals on its own and for this reason does not require any major accompanying measures. Patients need only watch for unusual symptoms and any side effects or drug interactions. If physical complaints such as allergies or gastrointestinal complaints occur during recovery, the physician must be informed. If intussusception is suspected, the hospital should be visited immediately. To avoid intensification of the protrusion, there should be no bowel movements until medical clarification is obtained. After a surgical procedure, as is also done under the impression of appendicitis, rest and bed rest apply. The patient may leave the hospital after a few days and should avoid, among other things, physical exertion and the consumption of laxative or irritating foods. The consumption of alcoholic beverages as well as caffeine and nicotine must also be reduced so that the surgical wound can heal without complications. After a few days, patients with lymphadenitis mesenterialis should consult their family doctor again. In the vast majority of patients, the disease of the lymph nodes heals without further complications or long-term health consequences.
