Parveen takes Gemma Hildon to the consultation room because she has heard that Gemma’s daughter has been rushed into hospital...

“Is Amy all right?” asks Parveen. “My daughter told me that she wasn’t at their dance class on Saturday and another friend said that she had been rushed to hospital with appendicitis.” It’s all been very dramatic, says Gemma. “School phoned me one day to say she was in quite a bit of pain, so I took her to the urgent care centre and the doctor packed us off to A&E saying he was sure she had appendicitis. “Everyone there seemed convinced that was the diagnosis too, but the blood test didn’t show anything. They did a scan the next morning and diagnosed mesenteric adenitis, but they didn’t really tell me much. Do you know anything about it?”

Answer

Mesenteric adenitis (also called mesenteric lymphadenitis) is inflammation of the lymph nodes in the membrane that attaches the intestine to the abdominal wall.

The most frequent cause is an infection, most commonly with the bacterium Yersinia enterocolitica. Other causes include some of the bacteria implicated in gastroenteritis and TB, several viruses including rubeola, adenoviruses, coxsackieviruses, Epstein-Barr and HIV, and some forms of cancer.

The bigger picture

The illness is commonest in children and adolescents, and presents with very similar symptoms to acute appendicitis: fever, appetite loss, tiredness, nausea and pain in the centre and lower right hand side of the abdomen.

For this reason a blood test and ultrasound scan are recommended for anyone with these symptoms. This is often the only way of differentiating between appendicitis (raised white cell count and C-reactive protein evident in a blood test and abnormal appendix on scan) for which surgery is indicated, and mesenteric adenitis (blood tests usually show no major abnormalities but lymph nodes will be enlarged on the scan), which normally resolves with only symptomatic treatment unless there is a more significant underlying cause.

Extend your learning

• Rovsing’s sign (rebound tenderness when the left lower abdominal quadrant is pressed and then released) is probably the most well known physical diagnostic test for acute appendicitis, but there are several more. Read about them at ncbi.nlm.nih.gov/pmc/articles/PMC4593043

• Find out why diagnosing appendicitis can be tricky at nhs.uk/Conditions/Appendicitis/Pages/Diagnosis.aspx

• Why would someone with acute appendicitis be urged to go to A&E? See cks.nice.org.uk/appendicitis#!backgroundsub:4

• An appendectomy is often carried out using keyhole surgery. Find out why shoulder pain is common after such a procedure at laparoscopyhospital.com/shoulder-pain-after-laparoscopic-surgery.html