Course of acute nonspecific mesenteric lymphadenitis: single-center experience

Efficacy of Prednisone in Children with Acute Nonspecific Mesenteric Lymphadenitis: A Pilot Study

BACKGROUND

Acute nonspecific mesenteric lymphadenitis (ANML) is a common cause of acute abdominal pain in children with no specific treatment.

METHODS

A total of 13 patients (6 boys, 7 girls) aged 7.3 (5-13.5) years with severe acute abdominal pain were evaluated using ultrasonography and laboratory tests to establish the diagnosis of ANML. They were treated with prednisone 1 mg/kg (max 40 mg daily) for a maximum of 5 days. The intensity of abdominal pain was evaluated before and after treatment using a numeric rating scale.

RESULTS

All patients had pain scores above 6/10 before, and below 4/10 after treatment with prednisone. Intensity of abdominal pain after treatment for 1-5 days decreased significantly (p < 0.001), with no recurrence at follow-up within 3 months. All other pre-existing signs and symptoms, such as nausea, vomiting, anorexia, fever, diarrhea, and constipation were found to disappear with no adverse effects of corticosteroid therapy.

CONCLUSION

These results suggest that the treatment with prednisone in selective patients with ANML can reduce the duration of abdominal pain.

Identifying threshold sizes for enlarged abdominal lymph nodes in different age ranges from about 200,000 individual's data

The threshold size for enlarged abdominal lymph nodes (E-ALNs), a common pediatric disorder, has yet to be standardized. According to the maximum short-axis diameter, this study divided ALNs into Grade A (≥ 10 mm), Grade B (8–10 mm), Grade C (5–8 mm), and Grade D (< 5 mm, normal). To identify the threshold size for E-ALNs, the prevalence of each grade was compared between asymptomatic individuals and symptomatic (e.g., abdominal pain) individuals without other diseases (e.g., appendicitis) that could explain the symptoms for different ages using data from > 200,000 individuals. The results showed the following: (1) For ages 1–3 years, the recommended threshold size is 8 mm, as the differences in the prevalence between the two groups were nonsignificant for Grade C but significant (p < 0.05) for both Grades A and B. (2) For ages 3–14 years, the recommended threshold size is 5 mm, as the differences between the two groups were significant (p < 0.05) for Grades A, B, and C. (3) The prevalence of Grades A, B, and C was very low for ages 0–1 years and high for ages 1–6 years. (4) The prevalence for males was generally higher than that for females for Grades A and B.

Reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children

There is no acknowledged reference interval of mesenteric lymph node size in healthy children, and the size criterion for mesenteric lymph node enlargement (MLNE) has long been controversial. This study aimed to explore the reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children and to develop a more appropriate definition of MLNE. The asymptomatic children included were divided into five age strata: 2 to 3 yr; 3 to 4 yr; 4 to 5 yr; 5 to 6 yr; and 6 to 7 yr. Correlation analyses between lymphocyte counts and the long-axis diameter, short-axis diameter, and average diameter of the largest mesenteric lymph node (LMLN) were performed. A reference interval of the short-axis diameter of LMLN was established according to this correlation analysis in each age group. We also report a reference interval of lymphocyte count in each age group. This study revealed significant correlations between the short-axis diameter of LMLN and lymphocyte count in all age groups, as well as in subdivided boy groups and girl groups. The overall reference interval of the short-axis diameter of LMLN in children was 0.54 cm—1.03 cm, with mean value of 0.75 cm. This study supports the use of the short-axis diameter greater than 8–10 mm as the diagnostic criterion for primary mesenteric lymphadenitis based on the presence of a cluster of three or more mesenteric lymph nodes and in the absence of other abnormalities.

Acute fulminant necrotizing mesenteric lymphadenitis causing bowel ischemia

This case report documents the medical progression of a 56-year-old man who presented with a small bowel obstruction and was found to have acute fulminant necrotizing mesenteric lymphadenitis causing small intestinal ischemia. A large portion of the proximal jejunal mesentery was necrotic with vascular thrombosis leading to small bowel ischemia and obstruction. He was successfully managed surgically and survived. The evaluation and possible aetiologies are discussed.