Mesadenitis in children: a multidisciplinary approach to diagnosis and treatment


Cite item

Abstract

The article presents research data on acute mesadenitis in children. Acute mesadenitis is a disease that still causes difficulties in diagnosis and treatment. Doctors of various specialties, such as pediatricians, gastroenterologists and pediatric surgeons, are still interested in this problem. The clinical picture of acute mesadenitis includes symptoms of an "acute abdomen", which makes it important for the differential diagnosis of other pathologies. The aim of the study is to identify the features of the etiology, clinic, diagnosis, and response to therapy of mesadenitis in Voronezh children. Mesadenitis is a fairly common disease, but approaches to diagnosis and treatment tactics cause difficulties for primary care physicians. It is more common in children aged 6 to 13 years due to the immaturity of their immune and digestive systems. Mesadenitis can be caused by infectious diseases, as well as the penetration of infection from other organs. The article will discuss etiology

Full Text

Relevance. Despite many years of experience, the problem of timely detection and treatment of acute mesadenitis has not been solved [1]. The practical interest of pediatricians, gastroenterologists and pediatric surgeons remains in this issue, since the clinical picture of acute nonspecific mesadenitis contains a symptom complex of "acute abdomen", which determines its importance in the differential diagnosis of various pathologies [2, 3]. Mesadenitis has a high prevalence, but remains unknown to a wide range of primary care physicians. Mesadenitis is a pathology that is accompanied by an inflammatory process in the lymph nodes of the mesentery of the intestine. It can occur as an independent disease or be a complication of other pathological conditions. At the same time, the risk factor is the immaturity of the immune and digestive systems, which causes more frequent occurrence in children. It is more common at 6-13 years of age. Pathological disorders in the gastrointestinal tract, including many infectious and urgent diseases, can lead to the development of mesadenitis; the penetration of an infectious agent into the mesenteric lymph nodes from a focus in the respiratory and genitourinary systems of the body. And also the cause of mesadenitis in children may be an infectious process that chronically persists in the body and is accompanied by periodic exacerbations [4, 5]. Etiologically, specific (tuberculous) and nonspecific (bacteria and viruses from the primary focus of infection) mesadenitis are isolated. Nonspecific mesadenitis is a more common type of disease, manifested in acute and chronic forms. Many cases of mesadenitis in children are associated with previous acute diseases of the nasopharynx and lower respiratory tract. Combined herpetic infection causes a prolonged course of the process [2]. When the pathogen penetrates into the lymph nodes, inflammation develops, up to suppuration with the appearance of necrosis sites and spread to the mesentery. Serous or serous-purulent effusion may form in the abdominal cavity. Clinically nonspecific mesadenitis hides under the "mask" of an acute abdomen and requires differential diagnosis in children with acute appendicitis. The main symptom is pain due to inflammation of the lymph nodes of the mesentery of the intestine. The nature of the pain varies from constant aching to cramping for several days. The general condition of the child as a whole is not disturbed [6, 7]. Sometimes there is an increase in temperature to subfebrile figures. Also, the child is worried about dyspeptic phenomena in the form of nausea, vomiting and stool disorders. In the case of the development of a purulent process in the lymph nodes, the symptoms become more pronounced – febrile fever, weakness, apathy, when examined, the defiance of the muscles of the anterior abdominal wall and palpable inflammatory infiltration. There may be positive peritoneal symptoms with the development of peritonitis. To make a diagnosis, it is important to make a differential diagnosis of acute abdominal syndrome with surgical pathologies: acute appendicitis, Meckel's diverticulum, acute and calculous cholecystitis, intestinal obstruction, gynecological pathology in girls - inflammatory diseases of the uterine appendages, ruptures of the ovarian cyst, ovarian apoplexy, torsion of the uterine appendages, primary pelvioperitonitis, congenital anomalies of the genitals, etc.; and also from urinary tract infection and urolithiasis [8]. On examination, the symptoms of McFadden may be positive (soreness at the outer edge of the right rectus abdominis), Klein (pain moving from right to left when the patient turns from back to left side), Sternberg (pain when probing the line connecting the right iliac region with the left hypochondrium). In a clinical blood test, only leukocytosis can be detected, indicating only an inflammatory process in the body [9]. Ultrasound examination allows you to identify enlarged and compacted lymph nodes and exclude pathologies of other organs with a similar clinical picture. Given the high resolution, non-invasiveness and speed of the study, this diagnostic method is widely used in clinical practice. At the same time, it is not always possible to fix the initial changes in the mesenteric lymph nodes. Confirmation and clinical diagnosis is often made after diagnostic laparoscopy or after repeated ultrasound. Diagnostic laparoscopy is the most accurate method of detecting acute mesadenitis and allows for a quick diagnosis, as well as avoiding delays in adequate treatment, but is not recommended for routine use. The indication for diagnostic laparoscopy in children should be considered a severe course of the disease with the development of complications, the ineffectiveness of conservative treatment. Surgical interventions performed against the background of COVID-19 in acute mesadenitis provoke complications and increase the duration of the recovery period [10]. The uncomplicated course of mesadenitis is usually limited to conservative therapy. Bed rest, diet, antibiotic therapy with broad-spectrum drugs (with specific mesadenitis, a chemotherapy regimen is selected), anti-inflammatory and painkillers. Surgical intervention is necessary in the development of purulent process and other complications [11]. Thus, the existing general provisions of the clinical examination do not allow for accurate diagnosis without resorting to invasive diagnosis.

The aim of the work is to identify the features of the etiology, clinic, diagnosis, and response to therapy of mesadenitis in Voronezh children.


Materials and methods of research. The present study was conducted on the basis of the MC "Healthy Child" and the CSTO No. 2 in Voronezh from May to December 2023. The present study involved 32 children aged 3 to 12 years: 17 boys (53.1%) and 15 girls (46.9%). Criteria for inclusion in the study: the age of the patient under 18 years, informed voluntary consent to the examination, confirmed mesadenitis according to the results of ultrasound examination (ultrasound). During the scientific work, all children were examined by a gastroenterologist on an outpatient basis with the preparation of a conclusion and a treatment plan followed by dynamic monitoring and evaluation of the effectiveness of the therapy. During the examination, complaints were clarified, anamnesis of the underlying disease and the life of the child (including family, social, household, hereditary) and an assessment of the special status were collected. All children were given recommendations on further additional methods of diagnosis and treatment. All patients underwent abdominal ultrasound and clinical blood analysis. Methods of nonparametric statistics were used to analyze the data obtained.

The results of the study. The etiological factors of mesadenitis are quite diverse, but most often the cause in children is an infectious process. According to our data on the causal factor, the data are presented as follows: ARVI preceded mesadenitis in 28.1% of cases, acute intestinal infections, COVID-19 and enteroviruses – 18.8% each, rotavirus infection – 9.4%, helminthiasis – 6.3%. The manifestation of symptoms of mesadenitis after an infectious and inflammatory disease most often occurred after 7-14 days in half of the cases (50.0%), for more than 14 days - 34.4%, up to 7 days - in 15.6% of children. After the onset of symptoms, they sought medical help in an average of 10 [6;21] days. The peak incidence was observed at the age of 5.9 years (59.4%) [5;7] from May to July (53.1%) and from September to October (28.1%). The treatment to the doctor was independent – 13 people (40.6%), as well as in the direction of a pediatrician (21.9%), a pediatric surgeon (28.1%), an infectious disease specialist (9.4%). According to concomitant pathology from other organs and systems, the data were divided as follows: in the anamnesis, chronic pathology was accompanied by gastroenterological (28.1%), allergic (25.0%), urological (3.1%), otorhinolaryngological (18.8%) diseases, while it was absent in 25.0% of children [12]. Against the background of the development of mesadenitis, appetite was reduced in 28.1%, unchanged in 41.0%, increased in 3.1% and unstable in 28.1% of patients. Fever was observed only in 21.9% of patients and subfebrility was more common (in 18.8% of children). According to the National Calendar, 28.1% were partially vaccinated, 59.4% were fully vaccinated, 6.3% were refused by parents and 6.3% were withdrawn. Severe abdominal pain disrupted the vital activity of 34.4% of the study group, while in 90.9% of children with abdominal pain, it decreased after the act of defecation. This fact increases the accuracy of differential diagnosis. On examination, palpation soreness in the umbilical region was 71.9%, in the right iliac region 12.5% and was diffuse in 15.6% of cases; soreness at the McFadden point is positive in 53.1% of cases, Klein's symptom is positive in 68.8% of cases, Stern's symptom is positive in 53.1% of cases. In addition to mesenteric lymph nodes, there was an increase in other groups of lymph nodes (submandibular, medial and posterior) in 31.3% of cases. The quality of stool in children was assessed according to the generally accepted Bristol stool scale. Constipation was detected in 18.8%: 1 point in 6.3% of patients and 2 points in 12.5%. Stool without abnormalities was found in most children: 12.5% had 3 points, 46.9% had 4 points and 21.9% had 5 points according to the scale. The study for herpesvirus infections (Einstein-Barr, CMV, herpes virus type 6) was conducted in 68.8% of patients by blood PCR. Of these, active infection was detected: in the form of CMV in 4.5%, EBV in 31.3%, HCV 6 in 13.6%, 50.0% - relatively healthy children. In the clinical blood test, isolated leukocytosis was observed in 28.1%, isolated increase in ESR in 18.8%, inflammatory syndrome (leukocytosis, increased CRP and ESR) in 12.5% and in 40.6% of cases, the hemogram was within normal limits. Mesadenitis was confirmed by ultrasound in 100% of cases. In a biochemical blood test, the average concentration of C-reactive protein was 1.05 [0.03;2.8] mg/l. When considering individual indicators of a clinical blood test, the average number of white blood cells was 8,6 [6, 7; 10, 6] 10^9/ l, lymphocytes were % 49 [34; 61], in absolute numbers 3.9 [2.8; 5.2] 109/l, all neurophils 3.9 [3.1; 5.5] 109/l, rod–shaped neutrophils - 3 [2; 4]%, segmetonuclear neurophils 52 [39;58]%. On average, the ESR was 6 [5;12] mm/hour. Symptomatic therapy (antispasmodic) showed improvement in 31.3% of cases. The remaining 68.7% were recommended to prescribe broad-spectrum antibiotics (penicillins, cephalosporins), which led to the complete disappearance of symptoms after 5 days in 34.4%, after 10 days in 18.8%. Unfortunately, antibiotic therapy did not have the desired effect in 15.6% of cases, such patients were recommended to consult a surgeon - 4 people (12.5%), and 1 person was referred to a hematologist due to the detection of pronounced hepatosplenomegaly during repeated examination based on CT results of the abdominal cavity.

Conclusion. Acute mesadenitis is an interdisciplinary problem of pediatrics and pediatric surgery, which requires qualified and consistent joint efforts of pediatricians and pediatric surgeons aimed at accelerating the provision of specialized care to a child.

×

About the authors

Victoria Vladimirovna Leonova

Federal State Budgetary Educational Institution of Higher Education «N.N. Burdenko Voronezh State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: vika.sorokina27072000@mail.ru
ORCID iD: 0000-0003-0416-1971
SPIN-code: 2890-6955

student

Russian Federation, 10 Studentskaya Street, Voronezh, 394036, Voronezh region

Saveliy Alexandrovich Leonov

Federal State Budgetary Educational Institution of Higher Education «N.N. Burdenko Voronezh State Medical University» of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: Savhrebet@ya.ru
ORCID iD: 0000-0002-7582-3066
SPIN-code: 5091-0402

student 

Russian Federation, 10 Studentskaya Street, Voronezh, 394036, Voronezh region

Yulia Yur'evna Razuvaeva

Federal State Budgetary Educational Institution of Higher Education «N.N. Burdenko Voronezh State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: y.y.razuvayeva@vrngmu.ru
ORCID iD: 0000-0003-2410-4544

Assistant of the Department of Faculty and Palliative Pediatrics

Russian Federation, 10 Studentskaya Street, Voronezh, 394036, Voronezh region

Vera Sergeevna Ledneva

Federal State Budgetary Educational Institution of Higher Education «N.N. Burdenko Voronezh State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: lvsmed@yandex.ru
ORCID iD: 0000-0002-8819-3382

Head of the Department of Faculty and Palliative Pediatrics, MD, Associate Professor

Russian Federation, 10 Studentskaya Street, Voronezh, 394036, Voronezh region

References

  1. Фаткуллинм Г.Р., Анохин В.А. Мезаденит и герпетические инфекции // Российский вестник перинатологии и педиатрии. - 2017. - №62(5). - С. 167-170.
  2. Разуваева Ю.Ю., Леднева В.С., Леонова В.В, Леонов С.А., Ульянова Л.В., Разуваев О.А. Ларингофарингеальный рефлюкс у детей, взрослых и паллиативных пациентов: проблемы и перспективы диагностики // Вестник Смоленской государственной медицинской академии. - 2023. - №4. - С. 160-169.
  3. Лелецкая А.В., Разуваева Ю.Ю. Постинфекционный астенический синдром у детей // Российский педиатрический журнал. - 2023. - №S1. - С. 29.
  4. Султонов Ш.Р., Абдуллоев М.Ф., Расулов С.С., Ахмедов Р.Ш., Курбанов Д.М., Гуриев Х.Д. Совершенствование методов диагностики и лечения острых заболеваний органов брюшной полости у детей // Детская хирургия. - 2019. - №23(1). - С. 40-43.
  5. Окунева А.И., Окунев Н.А., Кемаев А.Б., Солдатов О.М. Мезаденит в структуре острого живота у детей // Детская хирургия. - 2019. - №23(1). - С. 47.
  6. Вакуленко М.В., Анастасов А.Г., Харагезов А.М., Стрионова В.С. Диагностическая и лечебная тактика при мезадените у детей // Университетская клиника. - 2017. - №3-2 (24). - С. 20-22.
  7. Молочкова О.В., Ковалев О.Б., Шамшева О.В., Соколова Н.В., Сахарова А.А., Крылатова Н.И., Галеева Е.В., Корсунский А.А., Кащенко О.А. Бактериальные диареи у госпитализированных детей // Детские инфекции. - 2019. - № 4 (69). - С. 12-18.
  8. Курбанов Ж.Ж., Мавлянов Ф.Ш., Мавлянов Ш.Х., Хайитов У.Х. Неотложная видеолапароскопия при "остром животе" у детей дошкольного возраста // Детская хирургия. - 2020. - №24(1). - С. 47.
  9. Никитин С.С., Гусева Н.Б., Гольденберг И.Г., Тимонина А.В. К вопросу о дифференциальной диагностике причин мезаденитов: клиническое наблюдение абдоминальной формы туляремии у подростка // Педиатрия. журнал ил. Г.Н. Сперанского. - 2022. - №101(2). - С. 172-175.
  10. Барденикова С.И., Шавлохова Л.А.1, Шувалов М.Э. Острый мезаденит: взгляд педиатра // РМЖ. Медицинское обозрение. - 2019. - №3(5). - С. 2-10.
  11. Gorbatyuk O, Soleiko D, Kurylo H, Soleiko N, Novak V / Urgent durgical operations for crohn's disease in children / Georgian Med News – 2020 – Sep;(306) – С. 61-66.
  12. Разуваева Ю.Ю., Леднева В.С., Леонова В.В, Леонов С.А., Ульянова Л.В., Разуваев О.А. Гастроэзофагеальная рефлюксная болезнь у детей, в том числе у паллиативных педиатрических пациентов // Лечащий врач. - 2023. - №6. - С. 42-47.

Supplementary files

There are no supplementary files to display.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies