Background: Mesenteric lymphadenitis (ML) is a common finding in children with abdominal pain and considered the most common clinical entity to be considered in a child with suspected acute appendicitis (AA).
Unlike acute appendicitis, mesenteric lymphadenitis is considered a benign and self-limited condition. Establishing unique clinical and laboratory criteria for the diagnosis of ML might reduce unnecessary imaging and even surgical intervention.
The aim of this study was to assess clinical and laboratory parameters of patients with mesenteric lymphadenitis in comparison to those with acute appendicitis.
Methods: In this retrospective study patients diagnosed with ML (n=101) were compared in terms of demographics, clinical presentation and laboratory findings with patients diagnosed with AA (n=103).
Patients with ML were further stratified to those with lymph nodes smaller and larger than 1 centimetre and the difference between those parameters was analysed.
Results : Patients with ML had significantly increased duration of symptoms prior to ED presentation (2.3 days vs 1.4 days) and multiple referrals to the ED (1.3 vs 1.05). They also had lower total WBC counts (10.1x 10^3 vs 15.8X10^3) with lymphocyte predominance (24.5% vs 13.0 %) and low CRP levels (4.7 mg/dl vs 12.0 mg/dl)
Migration of pain (28% vs 7%), vomiting (63% vs 34% ) and rebound tenderness (72% vs 20%) were all significantly associated with AA.
No difference was found between those presenting with small and large lymph nodes.
Conclusions: this work is one of few studies that portraits the clinical and laboratory characteristics of ML, characteristics that may be incorporated to acute abdominal pain scoring systems.
More importantly the absence of any difference between small and large lymph nodes might support those who regard mesenteric lymph nodes enlargement in the paediatric age group as an incidental finding.
