Characteristic is an increase (or resumption) of pain during walking, during physical activity and, as a rule, the absence of its irradiation. Abdominal pain due to pathology of the mesenteric lymph nodes, unlike chronic intestinal diseases, is not accompanied by tenesmus and the passage of gas. Diffuse pain is more often noted and, less often, its localization in the right iliac or umbilical regions. Nausea and vomiting often accompany pain, especially when acute form diseases. Appetite is reduced, to the point of anorexia.

Abnormal stool manifests itself in the form of constipation, diarrhea or their change.

An increase in body temperature is observed in most patients with mesenteric lymphadenitis. An increase in heart rate, as a rule, corresponds to the degree of increase in body temperature, however, destructive forms of the disease are characterized by tachycardia and a discrepancy between the pulse rate and body temperature indicators.

Inspection. In patients with nonspecific mesenteric lymphadenitis, facial skin hyperemia is often expressed, herpes are sometimes noted, which are also often observed in various infectious diseases. The abdomen, as a rule, is symmetrical, its abdominal wall takes an active part in the act of breathing.

With nonspecific mesenteric lymphadenitis, upon superficial palpation, tension in the muscles of the abdominal wall is absent or weakly expressed and increases in the presence of free effusion into the abdominal cavity. With deep palpation, the zone of maximum pain is located slightly upward and to the left of McBurney's point (McFadden's zone), as well as along the root of the mesentery from McBurney's point towards the navel, spreading upward and to the left of it (Sternberg's symptom). It is also typical for the pain point to move when changing body position (Klein's symptom).

The following symptoms are of particular importance for the diagnosis of chronic nonspecific mesenteric lymphadenitis:

McFadden's symptom - pain on palpation At the outer edge of the right rectus abdominis muscle 2 - 4 cm below the navel or located above and inward from McBurney's point (the border of the outer and middle third of the line connecting the right anterior superior iliac spine with the navel) .

Sternberg's symptom is pain on palpation along the root of the mesentery from McBurney's point towards the navel, spreading up and to the left of it.

Klein's symptom is movement of the pain point to the left. When palpating the abdomen with the patient lying on his back, pain is noted 3–4 cm to the right and below the navel. Then the patient turns on his left side and remains in this position for 1 - 2 minutes.

When palpated in this position, the pain moves to the left of the navel and is absent in the right half of the abdomen. When the child is examined again in a supine position, the localization of pain moves to the right and disappears in the left half of the abdomen.

Tkachenko's symptom - when palpating the abdomen along the anterior midline with the patient lying on his back, there is pain in the area, the lower border of which is located 5 - 6 cm below the navel, while when examined in the Trendelenburg position it moves up to the level of the navel, and sometimes and higher. The symptom is used in differential diagnosis with acute appendicitis.

Mesadenitis

Mesadenitis is an inflammatory disease of the lymph nodes of the mesentery of the small intestine. The disease manifests itself as intense abdominal pain various localizations, which increase with exercise, increased body temperature, tachycardia, shortness of breath, nausea, diarrhea. To confirm the diagnosis, a surgical examination, laboratory tests, ultrasound and MRI are necessary. abdominal cavity. In controversial situations, diagnostic laparoscopy is performed. Treatment involves the prescription of dietary nutrition, antibiotics, painkillers and parenteral detoxification solutions. When suppuration occurs, abscesses are opened and the abdominal cavity is sanitized.

Mesadenitis

Mesadenitis (mesenteric lymphadenitis) is an inflammation of the lymph nodes located in the fold of the peritoneum, the main function of which is to suspend and attach the small intestine to the posterior wall of the abdomen. There are about 600 lymph nodes in the abdominal cavity, which perform a protective function and prevent the development of infection. The prevalence of mesadenitis among acute surgical pathologies is 12%. The disease mainly affects children and young people of asthenic physique between the ages of 10 and 25 years. Females are somewhat more likely to suffer from this pathology. The seasonality of the disease is noted: the number of patients increases in the autumn-winter period, when the number of patients with ARVI increases.

Causes of mesadenitis

The disease develops in the presence of a primary focus of inflammation in the appendix, intestines, bronchi and other organs. Lymphogenous, hematogenous or enteral (through the intestinal lumen) the infection enters the lymph nodes of the mesentery, where pathogenic microorganisms multiply. The following pathogens can cause the formation of mesadenitis:

• Viruses. Inflammatory lesions of the mesenteric lymph nodes can occur secondary to a viral respiratory tract infection, genitourinary system and gastrointestinal tract. Most often, mesenteric lymphadenitis is a consequence of adenoviral tonsillitis, pharyngitis, conjunctivitis, cystitis, enterovirus intestinal damage, infectious mononucleosis caused by the Epstein-Barr virus.
• Bacteria. The causative agents of mesadenitis can be both opportunistic microorganisms (staphylococci, streptococci, E. coli) - representatives of the normal flora of the mucous membrane of the gastrointestinal tract, nasopharynx, and pathogenic species of bacteria. Inflammation of the mesenteric lymph nodes can be observed with salmonellosis, campylobacteriosis, yersiniosis, generalization of the infectious process with tuberculosis of the bronchi, lungs, bones and joints, etc.

Predisposing factors to the development of mesadenitis are decreased immunity and associated inflammatory lesions Gastrointestinal tract. The predominant damage to children and adolescents is associated with imperfections of the immune and digestive systems, frequent food poisoning and ARVI.

Pathogenesis

The lymph nodes of the mesentery are a barrier to the penetration of infection from the intestines and internal organs into abdominal space. When a primary inflammatory focus exists (in the intestines, upper respiratory tract), infectious agents enter the lymph nodes by lymphogenous, enterogenous or hematogenous routes. In the presence of predisposing factors, the number of pathogenic microorganisms increases. Swelling and hyperemia of the mesentery occurs. Lymph nodes, mainly in the area of ​​the ileocecal angle, have a soft consistency and red color. When the lymph nodes suppurate, an infiltrate with purulent melting and areas of necrosis is formed. Generalization of the infectious-inflammatory process is accompanied by damage to the adipose tissue of the mesentery. Histological examination reveals leukocyte infiltration and lymphoid hyperplasia of the nodes, thickening and swelling of the capsule. Depending on the severity of mesadenitis, a serous or serous-purulent effusion forms in the abdominal cavity.

Classification

The disease causes damage to both individual lymph nodes and the whole group. According to the pathological process, acute and chronic mesadenitis are distinguished. Acute pathology is accompanied by sudden development and vivid symptoms. The chronic course of the disease has a blurred clinical picture for a long time. Depending on the type of pathogen, there are the following types mesadenitis:

1. Non-specific. It is formed when viruses or bacteria migrate from the main source of infection in the body. Nonspecific mesadenitis can be simple and purulent.

2. Specific. It is formed under the influence of Koch's bacillus (Mycobacterium tuberculosis) or Yersinia bacteria.

Symptoms of mesadenitis

The acute form of the disease is characterized by a sudden onset and rapid development of symptoms. Prolonged cramping pain occurs in the umbilical region or in the upper abdomen. In some cases, patients cannot indicate the exact location of pain. Intense pain is gradually replaced by dull and moderate soreness, which intensifies with a sudden change of location or coughing. The disease is manifested by fever, increased heart rate (bpm) and respiratory movements (25-35 per minute). Dyspeptic disorders increase: nausea, dry mouth, diarrhea, and single vomiting appear. Sometimes the disease is accompanied by catarrhal symptoms (runny nose, cough, hyperemia of the pharynx), herpes on the lips, wings of the nose.

With the formation of purulent mesadenitis, the intensity of pain decreases, intoxication of the body increases, and the patient’s general condition worsens. The chronic course of the disease is characterized by mild symptoms. The pain is mild, without specific localization, is short-term in nature and intensifies with physical activity. Occasional short-term nausea, constipation, or loose stool. Tuberculous mesenteric lymphadenitis is accompanied by a gradual increase in symptoms. Severe intoxication is noted with the development of weakness, apathy, pallor of the skin with the appearance of a sallow skin tone, and low-grade fever. The pain is aching, short-lived, and has no clear localization.

Complications

The progression of the disease can cause suppuration of the lymph node, the formation of an abscess and the development of purulent mesadenitis. Long course The purulent process leads to the melting and breakthrough of the abscess with the release of the contents of the lymph node into the abdominal cavity. As a result, peritonitis develops. When pathogenic microorganisms enter the blood, a serious complication occurs - sepsis, which can lead to death. The long course of mesenteric lymphadenitis contributes to the formation adhesive disease abdominal organs. Adhesions and cords of the peritoneum can lead to strangulation intestinal obstruction. In rare cases, the process generalizes with the development of extensive inflammation of the body's lymph nodes.

Diagnostics

Nonspecific clinical picture causes significant difficulties in diagnosing the disease. In order not to miss the development of serious complications, diagnostic procedures are recommended to be carried out in full. Diagnosis of mesenteric lymphadenitis includes:

• Examination by a surgeon. Palpation examination of the abdomen reveals dense, tuberous formations of various locations. There are positive symptoms of McFadden (pain along the outer edge of the rectus abdominis muscle), Klein (migration of pain from right to left when the patient turns from the back to the left side), Sternberg (pain when pressing along the line connecting the left hypochondrium with the right iliac region).
• Ultrasound of the abdominal cavity. This method allows you to determine dense enlarged lymph nodes, increased echogenicity in the mesentery. Examination of the gallbladder, pancreas, and spleen excludes the presence of diseases with similar symptoms (acute pancreatitis, cholecystitis).
• MRI of the abdominal cavity. Is the most informative and modern method diagnostics Allows you to determine the exact location, size and number of affected lymph nodes. This method helps to visualize changes in the gastrointestinal tract and other abdominal organs.
• Laboratory research. The CBC shows leukocytosis and an increase in ESR. A bacterial infection is characterized by a shift in the leukocyte formula to the left, neutrophilia; for viral - lymphocytosis. Blood culture for sterility allows you to determine the pathogen circulating in the blood. If the tuberculous nature of the disease is suspected, a Mantoux test and intradermal diaskintest are performed. To determine the pathogen or the presence of antibodies to it, specific serological blood testing methods (ELISA, RSK, etc.) are used.
• Diagnostic laparoscopy. It is performed when non-invasive diagnostic methods are insufficiently informative. The method allows you to visualize the affected lymph nodes, determine their number and location, and examine other abdominal organs to exclude concomitant pathology and carry out differential diagnosis. To establish a final diagnosis, material (lymph node) is collected intraoperatively for histological examination.

Differential diagnosis of mesadenitis is carried out with acute surgical pathology of the abdominal cavity: acute appendicitis, pancreatitis, cholecystitis, intestinal and renal colic, colitis, exacerbation of gastric ulcer and 12-PC. For pain in the lower abdomen, the disease is differentiated from adnexitis and ovarian apoplexy. Benign and malignant neoplasms, specific enlargement of mesenteric lymph nodes in HIV infection, syphilis, and lymphogranulomatosis may have similar symptoms.

Treatment of mesadenitis

The main task in treating the disease is to identify and sanitize the primary source of infection. In uncomplicated acute course of the disease, conservative therapy is used. Antibacterial drugs are prescribed etiotropically, based on the type of bacterial pathogen. For tuberculous mesadenitis, specific therapy is indicated in an anti-tuberculosis dispensary. Anti-inflammatory, painkillers, and immunostimulating drugs are prescribed symptomatically. For intense, prolonged pain, a perinephric block is performed. To reduce intoxication, parenteral detoxification therapy is performed.

For purulent mesadenitis, surgical treatment is indicated. The abscess is opened and drained with an inspection of the abdominal cavity. All patients are recommended to follow a diet (table No. 5). It is necessary to avoid fatty, fried, smoked foods, flour products, coffee, alcohol. Preference should be given low-fat varieties fish and meat, vegetable soups, cereals, fruit drinks. It is recommended to take food 4-5 times a day in small portions. Physiotherapeutic treatment includes magnetic therapy and UHF therapy. During the period of remission and rehabilitation it is indicated therapeutic exercises under the supervision of a physical therapy doctor.

Prognosis and prevention

The prognosis for mesenteric lymphadenitis is favorable when timely diagnosis and proper treatment of the disease. The development of complications can lead to severe, life-threatening conditions (peritonitis, sepsis, intestinal obstruction). The basis of prevention is the identification and treatment of chronic foci of inflammation, which can serve as a source of the formation of mesadenitis. For prevention great value has periodic medical examinations, maintaining a healthy lifestyle and strengthening the immune system (taking multivitamins, walking in the fresh air, hardening).

Mesadenitis

Mesadenitis (synonymous with mesenteric lymphadenitis) is an inflammation of the mesenteric lymph nodes. It can develop after diseases of the upper respiratory tract, tonsils, appendectomy, tuberculosis and other diseases as a result of the penetration of infection from the primary focus into the lymph nodes of the mesentery through hematogenous or lymphogenous routes. According to the course, mesadenitis is distinguished between acute and chronic. Mesadenitis is observed mainly in older children and is characterized by sudden onset pain not associated with food intake in the abdomen, in the navel or to the right of it, as well as in the right iliac region. The pain is cramping in nature and lasts for 2-3 hours. up to 5 days and are accompanied by dyspeptic symptoms. Symptoms of peritoneal irritation are mild. Differentiate mesadenitis from appendicitis, peptic ulcer etc. For mesadenitis, strict bed rest, local thermal procedures, painkillers and antispastic agents are recommended; for tuberculous mesadenitis, specific antibacterial therapy is carried out (see Tuberculosis). In case of acute purulent mesadenitis, urgent surgery is indicated.

Mesadenitis (synonymous with mesenteric lymphadenitis) is inflammation of the mesenteric lymph nodes. Mesadenitis is often observed in childhood and adolescence. According to the course, acute and chronic mesadenitis are distinguished. The cause of mesadenitis can be tuberculosis, but more often it is a nonspecific infection that penetrates from the primary focus (upper respiratory tract) hematogenously or through the intestinal tract with saliva and sputum. Mesadenitis can also be a reaction of regional lymph nodes to an inflammatory process in the appendix or in the intestine due to any infectious disease - bacterial or viral.

Clinical picture (signs and symptoms). Fulminant, or toxic, forms of mesadenitis are rare. Usually the patient's condition is not serious. The most persistent symptom is abdominal pain localized in the right lower quadrant or in the navel; the pain is cramping in nature and lasts from 2-3 hours to 5 days. There is nausea, sometimes vomiting. The temperature is either normal or 37.5-38°. On examination, the abdomen is symmetrical; tension in the abdominal wall muscles is usually not observed. Symptoms of peritoneal irritation are mild. In the blood leukocytosis is up to -.

With chronic mesadenitis, abdominal pain is of uncertain localization and short-term in nature. Intestinal dysfunction is often observed. Diagnosis is aided by the Sternberg symptom (pain along the root of the mesentery) and the symptom of “shifting pain” when the patient turns. Tuberculous mesadenitis also occurs with the same picture.

Acute (non-tuberculous) mesadenitis sometimes ends with suppuration of the mesenteric lymph nodes - purulent mesadenitis. In this case, the patient’s condition worsens significantly, the temperature becomes hectic, and the pulse is rapid. On palpation, moderate muscle tension is determined; sometimes it is possible to palpate the inflammatory conglomerate, which includes the omentum and adjacent loops of the small intestine. It is extremely rare that an abscess breaks into the abdominal cavity and peritonitis develops.

Acute mesadenitis has to be differentiated from appendicitis (see), however, all similar symptoms (pain, tension in the abdominal muscles, irritation of the peritoneum, etc.) with appendicitis are much more pronounced. Often, due to the difficulty of diagnosing acute mesadenitis, surgery is performed. Chronic mesadenitis is differentiated from diseases accompanied by mild abdominal pain, for example, helminthiasis, chronic appendicitis.

Treatment is conservative, strict bed rest, administration of antibiotics, for abdominal pain - painkillers and antispastic agents, heating pads. In case of acute purulent mesadenitis, urgent surgery is required.

Mesenteric lymphadenopathy

Mesenteric lymphadenopathy is much more common than expected. In many cases, this disease is mistakenly diagnosed as acute appendicitis, due to the fact that the clinical picture of these two diseases has many similar symptoms.

The most acceptable classification of mesenteric lymphadenopathy for clinical purposes belongs to Wilensky and Hehn. It distinguishes between:

• nonspecific mesenteric lymphadenopathy: simple, purulent
• tuberculous lesions of the mesenteric lymph nodes.

The etiological factor of mesenteric lymphadenopathy is infection, but the pathogenesis of suffering is not yet sufficiently understood. Many authors point to a direct dependence of the enlargement of the lymph nodes of the mesentery of the small intestines on the disease of the appendix. Some researchers point to the importance in the etiology of this suffering helminthic infestation intestines, others note the connection between the appearance of mesenteric lymphadenopathy and respiratory tract infection. Pathological changes are quite characteristic. Usually there is multiple damage to the lymph nodes of the mesentery of the small intestines; in a quarter of cases, only lymphadenitis of the mesentery of the ileocecal region is noted. More often, the glands are enlarged to the size of a bean, they are pink or red in color, on palpation they are soft and mobile between the leaves of the mesentery, the latter is swollen and hyperemic in the area of ​​​​the affected nodes. Both isolated damage to individual glands and the presence of bags of enlarged lymph nodes are noted. In the latter case, the inflammatory reaction from the peritoneum can be significantly expressed with the formation of plastic adhesions and cords, which can cause strangulation obstruction. An omentum soldered to the site of inflammation can cause a similar clinical picture. On the section, the tissue of the lymph nodes appears juicy, soft, their capsule is tense.

Microscopic examination reveals mesenteric lymphadenopathy, desquamative catarrh of the sinuses of the lymph nodes, enlarged follicles and medullary cords, swelling and thickening of the capsule, and vasodilation. In the presence of conglomerates of enlarged lymph nodes, an abscess may form in the center of inflammation. The microscopic picture is then complemented, in addition to hyperplasia of the lymphoid tissue, by the presence of migration of leukocytes, which largely infiltrate both the lymphoid tissue and the capsule of the lymph node. In the abdominal cavity during surgery, in half of the cases the surgeon notes the presence of exudate; serous effusion is more often observed, but there may also be serous-purulent and even hemorrhagic exudate, depending on the course of the process.

Symptoms of mesenteric lymphadenopathy

Children and young people from 10 to 22 years of age suffer most often; the disease has not been registered older than these years. Women are slightly more likely to get sick than men. Patients with an asthenic constitution predominate. Many authors note the seasonality of the disease precisely in that period of the year when they are more often observed colds, i.e. December - March. Some patients have concomitant catarrhal symptoms or have a history of flu-like symptoms in the days preceding the disease; in some of them, chronic tonsillitis. Before an acute attack of the disease, patients may feel vague pain in the abdominal cavity. During an attack, the body temperature rises sharply to 38-39°, the general condition of the patients is satisfactory, but they are somewhat lethargic and sometimes restless, in some cases herpes appears on the lips. 50% of patients have a history of nausea and vomiting. Abdominal pain occurs mainly in attacks at certain intervals, less often they are constant, which is why it is possible to suspect intestinal obstruction or renal colic. The localization of pain is varied, some patients complain of pain throughout the abdomen, others mainly in the right iliac region, and others - near the navel. On palpation, the abdomen usually remains soft and muscle tension doesn't happen. However, in one third of patients, muscle tension is expressed, which spreads to the entire right half of the abdomen; in these cases, the Shchetkin-Blumberg symptom is positive. The most significant pain is noted upon palpation at the outer edge of the rectus muscle 1-3 cm below the navel in the so-called McFadden zone of maximum pain. You should also check the symptom of mesenteric pain proposed by A. Ya. Sternberg to determine specific mesenteric adenitis. This symptom is that upon palpation, pain is expressed along the attachment of the mesenteric root and is felt by the patient in the right iliac region medial to the cecum and in the upper left part of the abdomen at the level of the second lumbar vertebra.

At laboratory research blood there is an increase in the number of leukocytes from 10 to 20 thousand; when studying the leukocyte formula, there is a slight shift of neutrophils to the left by 5-10%, ROE is slightly accelerated. There are no characteristic changes in the red blood, and the same should be said about the urine test. From the given clinical picture and symptoms of the disease, it is clear that there are no clear clinical and laboratory signs for acute mesenteric lymphadenopathy. Most often, this disease is mixed with acute appendicitis.

Treatment of mesenteric lymphadenopathy

IN inpatient conditions it is permissible to treat patients with mesenteric lymphadenopathy conservatively with antibiotics (penicillin, streptomycin), since good results are observed, but in relation to these patients one should maintain “armed surgical neutrality”, i.e. at any time be able to perform emergency surgery. If symptoms increase, surgery should be performed; More often, the preoperative diagnosis leans toward appendicitis, acute intestinal obstruction, or intussusception. If there is some doubt, it is more advantageous to operate with a right pararectal incision for better examination of the abdominal cavity and mesentery of the small intestines. Exudate from the abdomen is removed with an electric suction device and a novocaine blockade of the mesenteric root is made, after which one of the enlarged lymphatic mesenteric glands is taken for microscopic examination and a more precise determination of the nature of mesenteric lymphadenitis. The vermiform appendix must be removed, as many surgeons consider it to be the cause of mesenteric lymphadenitis.

In case of purulent melting of an enlarged conglomerate of inflammatory glands, you can use the technique of B. A. Tarasenko, who, after delimiting the abdominal cavity with gauze tampons, opens the abscess, drains its cavity with dry gauze, and then fills it with dry penicillin; the place of the abscess is closed from above with a sewn piece of free omentum.

The prognosis for acute mesenteric lymphadenopathy for life is favorable.

Mesenteric lymphadenitis, forms, causes

Mesenteric lymphadenitis (mesadenitis, inflammation of the mesenteric lymph nodes) can be:

• nonspecific (acute - simple, destructive; chronic - primary chronic, secondary chronic);
• specific (tuberculosis).

Nonspecific mesadenitis, causes

Nonspecific mesenteric lymphadenitis is frequent illness in children, adolescents and young adults. It is approximately 10% of total number acute surgical diseases; Girls get sick 2 times more often; persons of asthenic constitution and low nutrition predominate.

Etiology. The cause of nonspecific inflammation of the mesenteric lymph nodes is bacteria (staphylococcus, streptococcus, enterococcus, E. coli) and their toxins.

Pathogenesis. Bacteria and their toxins enter the body enterogenously. From the alimentary canal to the mesenteric lymph nodes, they penetrate through the intestinal mucosa if its integrity is violated by such pathological conditions as dysentery, enterocolitis, foodborne toxic infection, and helminthiases. It is known that in the final section of the ileum, stasis, mechanical damage to the mucous membrane, and slow passage of food masses are observed more often than in its other segments. This leads to the occurrence of catarrhal conditions, which facilitate the penetration of infection into the mesenteric lymph nodes. Often in ileum reverse reflux of colon contents occurs due to imperfection of the ileocecal valve, which leads to autoinfection and autointoxication. This explains the more frequent damage to the lymph nodes of the ileocecal group and the terminal part of the ileum.

Pathomorphology. The average size of unchanged lymph nodes ranges from 0.4 to 1 cm. With acute nonspecific mesadenitis, the size of the lymph nodes increases noticeably. Characteristic pathomorphological changes appear in them: dilation of the sinuses, accompanied by simple or purulent catarrh; desquamation of the endothelium, its infiltration with leukocytes; hyperplasia of follicles and pulpy cords. In a chronic inflammatory process, the tissue of the lymph nodes undergoes sclerotic and atrophic changes.

Specific mesadenitis (tuberculosis), development mechanism

Prevalence. Due to a noticeable decrease in the incidence of tuberculosis, both pulmonary and especially extrapulmonary forms, tuberculous mesadenitis is a rare disease. According to autopsies of patients who died from pulmonary tuberculosis, tuberculous mesadenitis occurs in 0.4-1% of cases.

Pathogenesis. In the development of tuberculous mesadenitis, hematogenous, lymphogenous and contact routes of infection spread are important, of which the leading role belongs to the lymphogenous route from the lymph nodes of the root of the lungs. The favorite localization of tuberculosis in the ileocecal region is explained by the richness of lymphatic tissue, to which Mycobacterium tuberculosis has a pronounced tropism.

Ed. prof. I.N. Bronovets

“Mesenteric lymphadenitis, forms, causes” – article from the Gastroenterology section

Diagnosis and treatment of mesadenitis

As you know, the lymphatic system is closely related to the immune system. It provides a quick response to any pathological process inside our body. Mesadenitis is an inflammation of the mesenteric lymph nodes in the abdominal region. To date, the exact cause of its occurrence is unknown. This disease occurs more often in children. Characterized by abdominal pain, elevated body temperature and general weakness. It is important to diagnose this process in time and begin treatment. After all, mesadenitis can have complications that are life-threatening.

Anatomy and functions of mesenteric lymph nodes

Mesenteric lymph nodes belong to the group of visceral lymph nodes. They are located along the abdominal aorta and collect lymph from all internal organs of the abdominal cavity.

Mesenteric lymph nodes are divided into two large groups:

The superior mesenteric lymph nodes are the largest group of visceral lymph nodes in the abdomen. They are characterized by:

• placement between the layers of the mesentery small intestine;
• number of more than 400 lymph nodes;
• normally not palpable, they cannot be seen;
• painless;
• lymph is collected from the ileum and most of the colon.

Inferior mesenteric lymph nodes:

• number from 10 to 60;
• located between the layers of the mesentery of the sigmoid colon;
• do not cause pain upon palpation;
• normally they cannot be felt or seen;
• lymph is collected from the sigmoid, descending colon and upper part of the rectum - that is, from the lower part of the intestine.

As for the functions of the lymph nodes, they are as follows:

• retention and elimination of pathological particles;
• providing an immune response;
• growth and differentiation of white blood cells;
• retention of cancer cells.

What can be noticed is that the number of mesenteric lymph nodes is quite large. They are the first to respond to any pathological processes in the intestines. Therefore, a change in their shape or other characteristics indicates diseases of the abdominal organs.

Why do mesenteric lymph nodes become enlarged and inflamed?

Mesenteric lymph nodes react to any change normal operation intestines. Be it inflammation, infection or damage.

Lymphadenopathy or lymphadenitis can be localized or generalized. The local form indicates a disease within one organ. A total increase indicates more serious and dangerous diseases.

Mesenteric lymphadenitis most often occurs due to:

Important! It is always necessary to treat foci of chronic infection, because they can cause mesadenitis

Pathogenic microorganisms can enter the mesenteric lymph nodes with blood or lymph flow, from foci primary infection. Foci of primary infection can be in the abdominal wall and in other parts of the body - tonsillitis, pharyngitis, caries.

What is mesadenitis, features in children

Mesadenitis is an inflammation of the lymph nodes of the intestinal mesentery, which is accompanied by pain and general intoxication. The clinical picture of this disease is typical. More common in children than in adults.

What is mesadenitis (nonspecific mesenteric lymphadenitis) and its characteristics:

• sudden onset, symptoms develop very quickly;
• paroxysmal severe pain in the abdominal area, a person cannot indicate their exact location;
• increase in body temperature.

Chronic mesadenitis is characterized by erased symptoms. The pain is mild, and sometimes there may be disturbances in bowel movements.

There is also specific form– tuberculous mesadenitis. It is characterized by:

• prolonged abdominal pain without precise localization;
• temperature rises to 37.5-38 degrees Celsius;
• loss of appetite and weight;
• compaction of other lymph nodes.

Enlargement of mesenteric lymph nodes of this origin must be confirmed by bacteriological examination.

Important! With mesadenitis, there is suppuration and necrosis of the mesentery, abscesses and sepsis, adhesions in the intestines, peritonitis

Features of acute nonspecific mesadenitis in children:

• children aged 6 to 13 years are most often affected;
• symptoms last from 2 to 3 days;
• acute pain in the abdomen and navel area of ​​varying intensity: the pain intensifies, then gradually goes away;
• nausea and vomiting;
• body temperature can increase to 39 degrees Celsius;
• pulse and heart rate increase;
• children complain of constipation or diarrhea;
• general fatigue, drowsiness, weakness.

In some cases, you can feel compacted painful conglomerates - mesenteric lymph nodes, which become inflamed. In this case we're talking about about the complicated form of the disease mesadenitis – purulent. This condition is a direct indication for surgical treatment.

What diseases occur with mesenteric lymphadenitis

At the moment, there is no single theory that would explain the cause of mesadenitis. It is only known that nonspecific mesadenitis is a disease of infectious origin. Therefore, presumably, mesadenitis can be caused by diseases such as:

• viral infections - acute respiratory viral infections, hepatitis, infectious mononucleosis, AIDS, measles, rubella;
• bacteria – typhoid fever, salmonellosis, intestinal yersiniosis, cat scratch disease, pseudotuberculosis;
• acute appendicitis;
• inflammatory diseases of the abdominal organs.

Mesenteric lymph nodes are a kind of barrier to pathogenic microbes from the intestines or other organs of our body. They trap them in their tissue and destroy them.

In some cases, when the infectious process is not very pronounced, lymphadenitis may go away on its own. It is more common in adolescents and children, girls get sick less often.

Methods for diagnosing mesadenitis

Enlarged mesenteric lymph nodes are diagnosed based on the patient’s complaints, clinical picture and data from additional research methods. To diagnose this disease, the following methods are used:

• general blood test;
• ultrasound examination of the abdominal organs;
• computed tomography.

A general blood test will show signs of an inflammatory process. These include an increase in the number of leukocytes, a shift in the leukocyte formula to the left - with bacterial origin. With viral genesis, lymphocytosis is observed in the blood. There will also be an increase in ESR. If tuberculosis infection is suspected, a Mantoux test should be performed.

Changed lymph nodes can be seen by ultrasound examination of the abdominal organs. They will be compacted and enlarged. We can also examine the pancreas, gallbladder and other organs. This will help eliminate their inflammation and put accurate diagnosis.

Computer diagnostics is the most informative diagnostic method. With its help, we see the structure of the node, its dimensions and contours. We have the ability to diagnose inflammatory processes in the intestines or other organs. This method gives a complete picture of the state of all body systems of the subject.

Which doctors treat mesenteric lymphadenitis?

Before treating mesadenitis, it is necessary to establish the cause of its occurrence. The tactics of further therapy and clinical recommendations depend on the cause. The following specialists know how to treat this disease:

The infectious disease specialist first of all questions and examines the patient in detail. He must accurately diagnose and identify the disease and microorganism that caused mesadenitis. Further treatment tactics are to select drug therapy, acting on bacteria. After the course of treatment, the condition of the lymph nodes returns to normal.

The otolaryngologist and dentist are engaged in eliminating the primary foci of infection. By curing carious teeth or chronic sinusitis, for example, the chance of suffering from lymphadenitis is significantly reduced.

A phthisiatrician treats mesadenitis of tuberculous origin. Therapy depends on the severity of tuberculosis. For a skin patient, a treatment regimen with anti-tuberculosis drugs, immunomodulators and vitamins is individually selected.

The help of a surgeon is resorted to in case of a complicated form of mesadenitis. He determines whether surgery is indicated and makes a differential diagnosis with other ailments. The abscess is opened and drained, and the abdominal cavity is inspected. After surgery, diet therapy is recommended.

Principles of treatment of mesadenitis

The treatment regimen for acute mesadenitis depends on the etiology of this process. Most often, conservative treatment is carried out in the surgical department. Therapy is as follows:

• limited physical activity;
• limited nutrition and plenty of drinking;
• broad-spectrum antibiotics;
• painkillers;
• physiotherapy.

Important! You cannot prescribe medications yourself, since after taking medications the clinical picture of the disease changes. This makes diagnosis very difficult

Let's take a closer look drug treatment mesadenitis. It includes broad-spectrum antibiotics:

What do you need to know about mesadenitis to prevent it?

Abdominal pain is a common occurrence in children of all ages. Parents need to be vigilant: at the first complaint of a child about discomfort in the tummy, you should consult a doctor, especially if the baby often suffers from viral infections, tonsillitis, or has chronic diseases (pyelonephritis, cholecystitis, gastroduodenitis, tonsillitis, otitis media, etc.). After all, the baby’s immunity may at some point fail to cope with the microbial load, and then serious diseases develop, one of which is mesadenitis.

What is mesadenitis

Mesadenitis is a disease that occurs when the lymph nodes of the intestinal mesentery become inflamed. It is also called mesenteric lymphadenitis or mesenteric lymphadenitis.

Lymph nodes located in the mesentery become inflamed and cause the disease mesadenitis

According to statistics, boys suffer from mesadenitis more often than girls. IN lately cases of diseases have become more frequent, which indicates a decrease in immunity among the child population.

Oddly enough, the intestines and mesentery have the most lymph nodes than anywhere else in the body. They serve as a barrier and protection when the body encounters an infection. Under certain conditions, a violent reaction of the lymphatic system begins, which is manifested by enlargement and inflammation of the lymph nodes.

Children with reduced immunity or congenital immunodeficiency (lack of immune cells) are at risk for developing mesadenitis.

Causes of occurrence in children

Inflammation of the mesenteric lymph nodes can be either an independent disease or a concomitant symptom of another (main) disease.

1. When mesadenitis is an independent disease, the causes of its occurrence are most often opportunistic infections, that is, those that inhabit the intestines healthy child, but do not cause disease. In conditions of decreased immunity, opportunistic microorganisms become pathogenic, the barrier functions of the lymph nodes weaken, which leads to the development of the disease. The most common infections:
   • viral (adenovirus, Epstein-Barr virus, enterovirus, cytomegalovirus);
   • bacterial (yersinia, staphylococcus, E. coli, salmonella, rarely mycobacterium tuberculosis).
2. As for secondary mesadenitis, that is, formed as a result of infection in the lymph nodes of the mesentery with blood or lymph flow, we can talk about mesadenitis against the background of appendicitis, enteritis, tonsillitis, pneumonia.

In medicine there are:

1. Specific mesadenitis (tuberculous) - caused by Koch's bacillus (Mycobacterium tuberculosis).
2. Nonspecific - caused by opportunistic human microflora (Yersinia, staphylococcus, Escherichia coli, Epstein-Barr virus):
   • simple (without purulent focus);
   • purulent (with the formation of a purulent abscess).

According to the nature of the course, mesadenitis is divided into:

• spicy;
• chronic.

Manifestations of mesadenitis

Symptoms of mesadenitis directly depend on the type and nature of the disease.

With simple acute mesadenitis the following is observed:

• severe constant or paroxysmal pain in the lower right corner of the abdomen or in the navel area;
• nausea and vomiting fountain;
• increase in body temperature up to 39°C;
• weakness;
• constipation or diarrhea.

You can correlate the development of mesadenitis with a recent flu, pneumonia or sore throat.

Simple purulent mesadenitis is rare in childhood. When it occurs, intoxication phenomena (headache, rapid heartbeat, lethargy, weakness) are added to the above complaints.

Specific mesadenitis (tuberculous) manifests itself in a sluggish course. In addition, it is characterized by:

• subfebrile body temperature (not higher than 38°C);
• enlargement of peripheral lymph nodes;
• loss of body weight;
• weakness;
• pale skin;
• periodic cramping or aching pain in the abdomen.

With pulmonary tuberculosis, it may be accompanied by a cough.

Diagnostics

The diagnosis is made based on:

• interviewing the patient (or his parents) about complaints, past illnesses, etc.;
• examination of the child - the color of the skin is assessed (with mesadenitis it is pale), tongue (wet, covered with a white coating), pulse rate (increased), breathing (rapid), body temperature (increased). When palpating the abdomen, there is pain near the navel and in the right iliac region (in the lower right corner of the abdomen), but there are no symptoms of abdominal tension. This distinguishes mesadenitis from appendicitis. Sometimes you can feel the enlarged lymph nodes of the mesentery; when pressed, vomiting may occur.

Additional examination methods are used:

1. Clinical blood test - increase in the number of leukocytes and increased speed erythrocyte sedimentation rate (ESR).
2. A biochemical blood test is prescribed to identify pathologies of the kidneys or liver.
3. Stool analysis occult blood allows you to detect bleeding in the gastrointestinal tract.
4. Stool tests and venous blood for helminths are prescribed to exclude helminthiasis.
5. Ultrasound diagnostics and X-ray examination. Echo signs of mesadenitis will be an increase in mesenteric lymph nodes over 5 mm in diameter. An echo sign of mesadenitis is an increase in mesenteric lymph nodes
6. Computed tomography is used in more severe cases.
7. Laparoscopy is a minimally invasive method in which a special device(laparoscope), which “removes” the abdomen from the inside and displays the image on the monitor screen. This device can also be used to perform micro-operations. Laparoscopy allows you to accurately establish the diagnosis, reducing the number of surgical interventions in children. During laparoscopy, a special device is inserted through two small incisions in the abdomen to film the abdomen from the inside.

It is important to understand that ultrasound examination reveals indirect signs of enlarged mesenteric lymph nodes. In children, a diameter of up to 5 mm is considered normal. The diagnosis of mesadenitis based on ultrasound data alone is not made.

Inflammation of the mesenteric lymph nodes: symptoms and treatment methods

The mesenteric lymph nodes, which are localized in the groin area, can become inflamed when exposed to certain external or internal factors, which will result in the development of a disease such as lymphadenopathy of the mesenteric lymph nodes. Very often, this disease is confused with acute appendicitis, because the symptoms of these pathologies are quite similar. To be able to distinguish lymphadenopathy from appendicitis, you need to know in what cases the development of the disease can occur and what its distinctive features are.

Why mesenteric lymphadenopathy may occur

The mesenteric lymph nodes of the intestine can become inflamed only due to the entry of certain bacteria and viruses into the body, namely, into these nodes. They enter through the general blood flow or lymph flow from the primary infectious focus or from the intestine itself, where the pathogenic microorganism is localized. The primary focus of infection can be concentrated either in the intestines or in another area, for example, in the appendix or upper respiratory tract.

The following infectious microorganisms and primary diseases can cause mesenteric lymphadenitis:

• enterovirus, which can also cause watery diarrhea, pain in the abdominal area, increased gas formation;
• The Epstein-Barr virus causes infectious and oncological pathologies, for example, progressive malignant tumors;
• streptococcus and staphylococcus are those harmful microorganisms that are localized in the human body, but do not manifest themselves pathologically until they decrease natural level immune system;
• Salmonella is a pathogenic microorganism that, when exposed, causes the development of a disease such as salmonellosis (damage to the gastrointestinal tract). intestinal tract, nearby lymph nodes);
• tuberculous microbacteria - the source of tuberculosis - a disease that can cause damage to the lungs, gastrointestinal tract, and nearby lymph nodes);
• the development of primary infectious mononucleosis - a disease that can cause not only damage to the mesenteric lymph nodes, but also such as cervical, peripheral, as well as organs - the liver, spleen;
• the development of primary Burkitt lymphoma - a malignant tumor that can form not only in the mesenteric lymph node, but also in the submandibular one.

A pathology in which the lymph nodes are enlarged is called lymphadenitis. This is a fairly frequently reported disease among children of all ages.

What is it?

Enlargement of normal-sized lymph nodes occurs as a result of a variety of causes. In normal condition, these collectors should prevent the spread of various infections throughout the body. Each lymph node consists of many individual immune cells called lymphocytes. They are the ones who should protect the body from various harmful microorganisms.

Severe inflammation leads to enlarged lymph nodes. It can be acute or chronic. When microbes enter or after exposure to a provoking factor, for the first time in life they speak of an acute process. If unfavorable symptoms remain for a long time or appear again after several months, then this clinical form is already called chronic.

Doctors consider lymphadenitis a secondary disease, since enlarged lymph nodes are a consequence, not a cause. This is caused by various pathological conditions and diseases. A child's immune system does not function as well as an adult's. This leads to the fact that reactions from the lymph nodes are quite common.

All medical classifications of lymphadenitis are based on the anatomical principle. Different forms of the disease are named based on the location where the enlarged lymph nodes occur. This classification allows doctors to more fully understand the area of ​​inflammation and successfully formulate the necessary treatment tactics.

For final formation lymphatic system at least ten years are required. Usually to adolescence it is already fully formed.

Lymphocytes

The most dangerous age, at which the lymph nodes are most susceptible to various infections and inflammation, is considered to be the time period before the age of five. Usually it is at this time that it is registered greatest number cases of diseases in children.

Reasons

A variety of factors can lead to the development of lymphadenopathy of the lymph nodes. Scientists note that up to 75% of cases of this disease are caused by various bacteria. They even identified a list of the most dangerous bacterial infections, which are most likely to cause enlarged lymph nodes.

These include:

• inflammation of the paranasal sinuses (sinusitis, sinusitis);
• inflammation of the internal structures of the ear (otitis);
• furunculosis and eczema;
• pyoderma and common purulent process on the skin;
• scarlet fever and diphtheria.

Scarlet fever

According to statistics, the development of lymphadenitis most often results from:

• Streptococcal infection.
• Staphylococci.
• Infection with Epstein-Barr viruses.

Bacteria can reach lymph nodes in various ways. Most often they get there along with the bloodstream. Microorganisms are also able to reach lymph nodes by contact or through the lymph flow. Getting inside the lymphoid tissue of the lymph node, they cause severe inflammation there. This inflammatory process provokes an increase in the size of the lymph node, and also causes other unfavorable symptoms of the disease in the child.

In pediatric practice, there are also forms of lymphadenitis caused by viruses. These microscopic microorganisms easily enter the body by airborne droplets, as well as directly into the blood. Typically, viral lymphadenitis is serous. Bacterial species already cause purulent inflammation. Adverse symptoms of lymphadenitis due to a viral infection appear, as a rule, already 2-5 days after the onset of the disease.

Swollen lymph nodes can even be a consequence of a simple flu infection. The following also lead to the development of lymphadenitis in children: viral diseases: rubella, viral acute tonsillitis, mumps, chicken pox and others. After recovery, all unfavorable symptoms of inflammation of the lymph nodes disappear.

Parents with pets in their homes should be very careful. Often, ordinary scratches can lead to the development of lymphadenitis in a child.

Cats are carriers of a dangerous disease - felinosis. At the same time, this disease practically does not manifest itself in them. If a pet with this disease bites or scratches a baby, the child may also become infected.

Felinosis manifests itself in children as various types of lymphadenitis.

Felinosis

Scientists have established the most common causes of inflammation of the lymph nodes in children over six years of age. These include: toxoplasmosis, tuberculosis, mononucleosis, brucellosis, actinomycosis, syphilis and osteomyelitis, as well as various dental diseases(odontogenic diseases). Untimely treatment of carious or pulpy teeth leads to very rapid spread infections to the lymph nodes. In this situation, the lymph nodes located under the jaw are predominantly affected.

Not only various infectious agents can cause lymphadenitis in children. Enlarged lymph nodes may be a secondary manifestation of other diseases.

Lymphosarcoma

Currently, scientists have begun to note the emergence of “medicinal” lymphadenitis. This form of the disease occurs as a result of an overdose of drugs or when they are used for an excessively long time. This variant of lymphadenitis is recorded in no more than 3-5% of cases. To eliminate adverse symptoms a revision of the treatment and complete abolition of the drugs that provoke the disease are required.

Enlarged lymph nodes due to various pathologies can occur almost anywhere: under the armpit, on the neck, in the abdominal cavity, in the groin, on the head, under the jaw.

Such a variety of clinical variants of the disease entails the need to use nosological classification. It indicates the various forms of the disease, taking into account the main classification characteristics.

Species

Currently, doctors use several classifications. So, taking into account the prevalence of the process, all lymphadenitis is divided into regional and generalized. Common forms occur mainly in weakened and frequently ill children, as well as in children with various forms of immunodeficiency conditions.

All regional lymphadenitis can be divided into several clinical options:

• Inguinal. Characterized by enlarged lymph nodes located in the groin area. According to statistics, this form of lymphadenitis is most often recorded in boys. Often inguinal lymphadenitis is a consequence of diseases of the genitourinary organs.
• Cervical. Occurs in almost 80% of cases. Most often occur in children under 10 years of age. Called for various reasons, including numerous pathogens.

• Submandibular. Occurs as a result of reactive inflammation, occurring in the lymph nodes located below lower jaw. Bad teeth are also a common cause of this form of lymphadenitis in children. They are characterized by a persistent course and are usually difficult to treat. Lymphadenitis can persist in a child for a long period of time.
• Axillary. Most often recorded in systemic diseases. May also occur when tumor processes, as well as for some infectious diseases. According to statistics, they are more often registered in girls. Often the process is one-sided.
• Mesenteric. Characterized by enlarged mesenteric lymph nodes located in the abdominal cavity. Excessively enlarged lymph nodes cause various abnormalities in the functioning of the gastrointestinal tract, including the intestines. Some forms of mesenteric lymphadenitis are characterized by an enlarged liver.

Doctors also identify several clinical variants of the disease, differing from each other in the timing of the onset of adverse symptoms. This classification includes the following forms:

• Spicy. Usually the first adverse manifestations of the disease completely disappear within 2-3 weeks from the moment of their occurrence. After the acute process subsides, complete recovery occurs.
• Subacute. Adverse symptoms may last for a couple of weeks to a month. If the course of the disease is favorable, recovery also occurs. If the disease is severe, then complete cure does not arise.
• Chronic. Characterized by the persistence of unfavorable symptoms of the disease for more than a month. Typically, this variant of the disease occurs in waves: periods of exacerbations are followed by remission. To eliminate unfavorable symptoms and prevent long-term consequences of the disease, complex treatment is required.
• Reactive. In this case, all clinical manifestations illnesses occur in the baby literally within a few hours. Due to the illness, the child’s well-being suffers greatly. The baby may feel very weak, refuses to eat, and begins to be very capricious.

Inflammation that occurs in the lymph nodes can have various clinical variants:

• Serous. Doctors also call this form infiltration. Usually occurs with viral infections. The course of the disease, as a rule, occurs in a mild or moderate form.
• Purulent. The development of this form is facilitated by the previous infection with a bacterial infection. The inflammatory process is usually quite acute and causes multiple adverse symptoms. Purulent lymphadenitis is accompanied by a pronounced increase in body temperature, often to febrile levels. To eliminate adverse symptoms, a prescription is required high doses antibacterial drugs.
• Necrotic. A rather unfavorable option for the development of the disease. This form leads to complete necrosis (death) of the affected tissue areas. The course of the disease is extremely unfavorable. Treatment is carried out only in a hospital setting. If the condition is very serious, the baby may be hospitalized in the intensive care unit.
• Adenophlegmon. It is also an extremely unfavorable option for the development of the disease.. To eliminate symptoms, a whole range of different medications must be prescribed. Treatment is carried out strictly in a hospital setting. The prognosis is conditionally favorable.

Acute cervical lymphadenitis. This form of the disease is the most common. It often occurs in children after past infections. These include: influenza, acute tonsillitis, colds, respiratory diseases, childhood infections and others. Cases of enlarged cervical lymph nodes due to pneumonia have been reported. Variants of odontogenic lymphadenitis are also common.

A fairly common path of inflammation is the transition of a purulent process from the paranasal sinuses.

Babies who have had severe sinusitis or sinusitis have a high chance of developing lymphadenitis. The development of this condition usually results from decreased immunity. Children who are often ill or weakened, according to statistics, get sick much more often than their healthy peers.

The peak incidence of cervical lymphadenitis occurs at the age of 6-10 years. At this time, the lymph nodes are most vulnerable to various infections. This feature is due to the physiology of the child’s body. The overwhelming number of cases cervical lymphadenitis occurs due to infection bacterial infections. They account for more than 70%.

To eliminate adverse symptoms associated with enlarged lymph nodes, it is used the whole complex various medicinal and physiotherapeutic procedures. Usually, at least 2-3 weeks of active treatment are required to normalize the condition. In some cases it may even take several months. The baby’s condition is monitored at all stages of treatment of the disease.

Inguinal lymphadenitis. This clinical variant of the disease is characterized by enlarged lymph nodes in the groin. They can be enlarged in both girls and boys. However, according to statistics, boys are more susceptible to inguinal lymphadenitis. The symptoms of the disease are the same as with other clinical forms.

In most cases inguinal lymphadenitis has a serous variant. However, there are also purulent types. Late diagnosis leads to the fact that they become dangerous forms- abscesses. These purulent formations can easily burst with the flow of pus from the wound. If a purulent abscess forms, immediate treatment is required. medical care.

Mesenteric lymphadenitis. This clinical variant of the disease occurs with enlargement of the lymph nodes located in the mesentery. It is also a secondary manifestation of many diseases of the internal organs. Mesadenitis can be acute or chronic. Children with this pathology are seen not only by a pediatrician, but also by a pediatric gastroenterologist. In some cases, a consultation with a surgeon may be required.

Mesadenitis occurs mainly at older ages. Enlargement of the lymph nodes located in the abdominal cavity leads to the appearance of various unfavorable symptoms. The most characteristic sign of the disease is the appearance of cramping or cramping pain in the abdomen. The most dangerous course of the disease is in infants, when the child cannot yet tell his mother or doctor about his symptoms.

Inflammation in the abdominal cavity can cause many various complications. With a pronounced purulent process, inflamed lymph nodes can burst with pus flowing into the peritoneum. This leads to the development of purulent abscesses, and in some cases even to the occurrence of sepsis.

Initial therapy for mesenteric lymphadenitis is the administration of anti-inflammatory and antibacterial agents. If the treatment is ineffective, in some cases surgical treatment is required. Indications for surgery are determined by a vascular or abdominal surgeon. The prognosis of the disease is conditionally favorable.

Symptoms

The severity of the symptoms of lymphadenitis depends on many reasons. The most important include: the age of the child, the presence of immunodeficiency conditions, prematurity at birth, chronic concomitant diseases. In very young children, the disease usually occurs with severe symptoms and can even progress to chronic form.

For various options lymphadenitis is characterized by:

• An increase in the size of different groups of lymph nodes. In some cases, lymph nodes even become visible upon visual inspection from the outside. The skin over them may or may not be changed. This depends on the clinical form of the disease. In some forms, the skin over the lymph nodes becomes bright red or even fiery scarlet.
• Pain or sensitivity to palpation. When palpating the lymph nodes, it can be noted that the child experiences some discomfort. With severe lymphadenitis, severe pain appears. It can intensify after a hot bath or sauna, as well as during active physical activity.

• Adherence to the skin. When palpating the lymph nodes, you can notice their pronounced mobility. This occurs due to severe inflammation in the lymphoid tissue of the lymph node. In some diseases, the lymph nodes remain tightly fused to the skin and do not move.
• Symptoms of intoxication. All purulent lymphadenitis occurs with an increase in body temperature to subfebrile or even febrile levels. Against the background of such a febrile condition, the baby may show signs of fever or even severe chills. The general condition worsens, thirst develops.
• Child behavior disorder. During the acute period of the disease, the baby becomes more lethargic and does not play well with toys. Many babies do not attach well to their mother's breast. Their appetite often suffers and their sleep is disturbed. The child may become quite passive.

These symptoms are basic. They appear in almost all clinical forms of lymphadenitis. It is not always possible to suspect mild forms of the disease at home. Often, additional consultation with a specialist is required to establish the correct diagnosis.

Diagnostics

If you notice enlarged lymph nodes, take your child to the doctor immediately.

Sometimes lymphadenitis is the first clinical marker of very dangerous diseases, including oncological neoplasms. Under no circumstances should you delay seeking medical help! This can lead to the disease becoming chronic or worsening the course of the disease.

Lymph nodes, increasing in size, become accessible to palpation. By feeling, you can also determine their estimated diameter. In some cases, they acquire the size of a “pea” or “bean”. Be careful when conducting a home inspection! Do not try to press too hard on swollen lymph nodes. Such treatment can only intensify the inflammatory process.

When signs of lymphadenitis are detected in a child, parents are truly confused. They don't know which doctor to turn to for help. First of all, you should make an appointment with a pediatrician. He will examine the child and do preliminary conclusion about what disease could cause enlarged lymph nodes in the baby.

In some cases, the doctor will send the child for a consultation with an infectious disease specialist, rheumatologist, cardiologist or gastroenterologist. These specialists will help establish a correct and accurate diagnosis. Some clinical situations are quite difficult. In this case, a real medical consultation is required, in which several doctors of various specialties will participate. Establishment correct diagnosis- a necessary step for drawing up correct tactics treatment.

After carrying out all the necessary clinical examinations Doctors will prescribe several laboratory and instrumental tests for the child. They are needed to further verify the diagnosis. All children with lymphadenitis are prescribed:

• General clinical blood and urine tests. These simple tests can help identify possible infectious cause diseases, and also establish step less severity of functional disorders.
• Biochemical blood test. Necessary to identify the primary focus. It is often prescribed to exclude concomitant diseases, including kidney and digestive system diseases.

• Cytological and histological examination. To carry out this analysis, a small piece of the lymph node is first taken using a puncture. In a special laboratory, laboratory doctors examine the material according to the main clinical signs. This test is highly informative and allows you to establish the cause of the disease.
• Culture of inflammatory exudate. Usually this study carried out in combination with histology. This test gives a fairly accurate idea of ​​what type of inflammation has occurred in the lymph nodes. During the study, it is possible to additionally establish the sensitivity of the detected microorganisms to various types of antibiotics and bacteriophages.
• Puncture of lymph nodes. After this procedure, a histological examination is required. It allows you to make a diagnosis in 98% of cases. This test is highly specific and has been successfully used in pediatric practice for many years to establish correct diagnoses.

• Radiography. The method has a fairly high radiation dose. Prescribed to children only according to strict indications. X-rays are not usually used for children under two years of age. The study provides a descriptive picture of the presence of many diseases, however, it does not have high sensitivity and specificity.
• Ultrasound examination. Appointed to establish true dimensions inflamed lymph nodes. The method gives an accurate picture of the existing pathology in the lymph nodes.
• Computer and magnetic resonance therapy. They are prescribed only in complex diagnostic cases when establishing a diagnosis using other methods is impossible. The methods are highly informative and accurate. During the examination, the child does not experience any pain.

Treatment

Therapy for the disease is usually complex. To eliminate adverse symptoms, doctors prescribe various combinations of medications. They can be used in the form of tablets, injections, and severe course diseases - in the form of droppers and various infusions.

Treatment of any lymphadenitis is stepwise. Funds are assigned first conservative therapy. These include anti-inflammatory and antibacterial agents.

Antibiotics are prescribed only in cases where a purulent process is established or bacteria were identified during diagnostic tests.

Currently, broad-spectrum antibacterial drugs are used. They effectively fight several types of bacteria at once. For the treatment of various forms of lymphadenitis, the following are prescribed: clavulanic acid-protected penicillins, cephalosporins last generations, fluoroquinolones and others. The course of antibiotic therapy is usually 10-14 days. During treatment, mandatory monitoring of the effectiveness of the prescribed treatment is carried out.

When a viral cause of the disease is determined, antiviral drugs are prescribed. They are usually recommended for use for a shorter period. On average, it is 5-7 days. Antiviral drugs are prescribed in combination with anti-inflammatory drugs. This combination allows you to achieve the best results in the shortest possible time.

Anti-inflammatory drugs help eliminate symptoms of intoxication. To reduce body temperature, medications based on paracetamol, nimesulide, ibuprofen and others are used. These funds are prescribed for symptomatic treatment. Medicines should be used only when the temperature rises above 38 degrees.

Also to remove bacterial toxins from the body requires plenty of warm fluids. It helps normalize the child’s well-being much faster. Compotes and fruit drinks made from various fruits and berries are good drinks. Both fresh and frozen fruits are used for their preparation.

Subacute and chronic lymphadenitis can be treated using physiotherapeutic methods. However, it must be taken into account that these methods also have a number of contraindications. For example, it is undesirable to use them in children with cancer and rheumatological diseases. To eliminate lymphadenitis, various methods of magnetic therapy, ultrasound, infrared radiation and many others are used.

If conservative treatment is ineffective, they may be prescribed surgical operations. It is important to note that their indications are strictly limited.

Typically, operations are performed only on older children. Most cases of lymphadenitis go away on their own or after conservative treatment and do not require surgical therapy.

Prevention

An important element of preventive measures for lymphadenitis is strict control over the course of any infectious pathology in the body. All untreated infections can cause signs of lymphadenitis. To prevent inflammation in the lymph nodes, mandatory monitoring of the condition of the teeth is required. It is better to treat caries in the earliest stages, preventing the development of pulpitis.

Children, especially in the first years of life, must be vaccinated against all childhood infections, taking into account their age.

Common causes of lymphadenitis in children preschool age become common “quarantine” diseases. Many of them are quite easy to prevent. To do this, you just need to give your child all the necessary vaccinations on time.

Strengthening the immune system is also an important component of preventing lymphadenitis in children. Proper nutrition, healthy sleep and active games in the fresh air will guarantee a good mood and excellent functioning of the immune system. Your baby should be taught a healthy lifestyle from the very first days. This useful habit will help him be active and not get sick in the future.

To learn what to do if your lymph nodes are enlarged, see the following video.

• Lymphadenitis
• On the neck

Few people know that according to statistics, every 7-8 children under the age of 10 who are hospitalized surgical department with a presumptive diagnosis of acute appendicitis, in fact there is another, no less dangerous, surgical pathology - acute mesadenitis.

What is mesadenitis?

Mesenteric lymphadenitis (otherwise mesadenitis) refers to the inflammatory process in the lymph nodes, which are located deep in the mesentery of the small intestine.

The mesentery is a ligament of layers of serous membrane that secures the intestinal loops to the walls of the abdominal cavity. This pathology is more common in childhood.

In our abdominal cavity there are about 450-600 lymph nodes, which are a kind of protective barrier to possible infections.

Several forms of mesadenitis have been identified in children and adults

Depending on the type of infectious agent:

• Specific mesadenitis– yersinia (source – bacteria that cause intestinal infection) and tuberculosis (mycobacterium tuberculosis can also affect mesenteric lymph nodes).
• Non-specific– caused by streptococcus and staphylococcus, which are normally inhabitants of every organism. However, with a decrease protective forces immune system have a pathogenic effect.

According to the course, mesenteric lymphadenitis can be acute and chronic:

• Acute – symptoms appear suddenly and are accompanied by general intoxication syndrome.
• – painful symptoms bother the patient for several weeks or months.

Causes of mesadenitis in children

Viruses and bacteria can enter the intestinal lymph nodes from the cavity of the intestine itself or with blood and lymph traveling through their vessels from the primary infectious focus.

The main causative agents of acute nonspecific mesadenitis are:

• Beta-hemolytic streptococcus and Staphylococcus aureus, which cause diseases such as acute tonsillitis, otitis media, pharyngitis.
• Adenoviruses leading to acute respiratory infections.
• Epstein-Barr virus (is the source of infectious mononucleosis).
• Salmonella, Campylobacter, Escherichia coli (common causative agents of intestinal infections in children).

Symptoms of mesadenitis

With acute inflammation of the lymph nodes in the abdominal cavity in children, the following clinical manifestations of the disease are observed:

The pain has a sudden onset and is localized in upper sections abdomen or in the umbilical region and is dull and permanent. Painful sensations, usually long-lasting, can become more intense when coughing and changing the patient’s body position.

In some cases, the pain may disappear on its own. However, as the disease progresses and purulent inflammation forms in the intestinal lymph nodes, serious complications such as intestinal obstruction or peritonitis (acute inflammation of the peritoneum) often develop.

Symptoms of intoxication manifest themselves in the form of increased body temperature, up to 38.5-39.5 ° C, rapid breathing and heartbeat, headache, and weakness.

In some cases, symptoms of a digestive disorder are added: a feeling of dryness or bitterness in the mouth, nausea, often repeated vomiting, decreased or loss of appetite, and abnormal bowel movements.

Chronic mesadenitis is characterized by mild manifestations that do not significantly worsen the general condition of the patient.

The symptoms of acute mesadenitis in adults are not particularly different from those in children.

As a rule, it is possible to assume acute inflammation of the lymph nodes in the intestines of a child based on the characteristic clinical manifestations of the disease.

In addition to a general examination and questioning of the patient, the doctor must check specific symptoms, characteristic only for mesadenitis, which will help him in differential diagnosis with other similar pathologies:

• Klein's symptom - when the body position changes from the back to the left side, the pain will also move from right to left.
• McFadden's sign– when palpating a point located on the left edge of the rectus abdominis muscle and 4 cm below the umbilical ring, pain appears.
• Steinberg's sign– painful sensations when palpating the border of the left hypochondrium at the intersection with the right lower abdomen.

Diagnostics

IN mandatory laboratory research methods are prescribed. Clinical and biochemical tests blood tests will help determine the presence of inflammation and the degree of damage to organs adjacent to the inflammatory focus. General analysis urine tests are carried out to monitor the condition of the kidneys and urinary tract.

In case of a serious condition of the child, accompanied by severe intoxication, it is prescribed bacteriological examination blood. With its help, the causative agent of the disease and its sensitivity to antibiotics are isolated.

If a specific process is suspected, a tuberculin test (otherwise known as the Mantoux test) is performed and the patient's blood is examined for the presence of Yersinia DNA using polymerase chain reaction.

When diagnosing mesadenopathy in children, additional research methods can also be used. By using ultrasound examination abdominal cavity can be detected increased in size and with increased density lymph nodes.

Thanks to diagnostic laparoscopy, the surgeon will not only identify altered lymph nodes, but will also be able to take any area for biopsy.
If more detailed data on the condition of the internal organs is needed, a computed tomography scan is prescribed.

Treatment tactics

Treatment of mesadenitis in children and adults is not particularly different. All patients diagnosed with mesadenitis are urgently hospitalized at the clinic.

First of all, you need to follow a special diet, namely table No. 5: confectionery, fatty meat and fish, spicy seasonings, coffee, alcoholic beverages and instant foods are excluded. It is recommended to eat as much as possible fermented milk products, cereals, fruits, chicken and lean beef. Meals should be fractional.

Physical activity should be limited.

Therapy aimed at the cause of the disease includes taking antibacterial drugs. Basically, these are drugs with a wide spectrum of action: fluoroquinolones, protected penicillins, cephalosporins of the latest generations.

Since inflammation of the mesenteric lymph nodes is accompanied by severe pain, it would be advisable to prescribe analgesic and antispasmodic drugs. For unbearable pain, a perinephric block is sometimes used, when an anesthetic drug is injected into the fatty tissue surrounding the kidneys.

To eliminate intoxication, glucose-saline solutions are injected intravenously.

In some cases, when the source of inflammation is still tuberculosis bacilli, treatment is carried out with a combination of special antibiotics in the conditions of an anti-tuberculosis dispensary.

After removal acute inflammation Physiotherapeutic procedures will greatly help in recovery. For example, UHF is a therapy that applies dry heat to the sore area, massage, and electrophoresis.

An independent organ that performs protective, integumentary, endocrine, vascular, and immune functions is the intestinal mesentery. For hundreds of years, it was believed that this ligament was necessary for humans only to attach organs to inner surface abdominal cavity, i.e. for walking upright.

Features of the structure, blood supply, innervation leave an imprint on the development and course of the following diseases:

• rectal and colon cancer;
• inflammation;
• diverticula;
• cardiovascular diseases;
• diabetes;
• dysmetabolic syndrome;
• constipation;
• increased body weight.

Inflammatory diseases

The mesentery reacts to inflammation that develops in all parts of the gastrointestinal tract.

Involved in the process during the following processes:

• nonspecific ulcerative colitis;
• peritonitis;
• purulent foci located near the kidneys and spleen.

Inflammation of the mesentery - mesenteritis has nonspecific symptoms, is diagnosed as an independent disease extremely rarely, and is complicated adhesive process and intestinal obstruction.

Inflammation of the mesenteric lymph nodes is called mesenteric lymphadenitis. Inflammation can be:

• specific, for example, for tuberculosis;
• nonspecific – with adenoviral, enterovirus infection, staphylococcal, acute intestinal infection, for example, salmonellosis.

When diverticula form, there is a protrusion of the intestinal wall, which inevitably leads to fecal stagnation and inflammation. Long-term infection leads to perforation of the diverticulum into the mesentery. Gradually, the process spreads and retroperitoneal phlegmon develops - diffuse purulent inflammation of the adipose tissue of the cellular spaces.

Lymph nodes of the intestinal mesentery can respond to inflammation with both a quick lightning-fast response and a chronic sluggish reaction. The more acutely the disease manifests itself, the easier it is to diagnose and treat, since its symptoms increase rapidly, and patients consult a doctor early. This significantly improves the outcome of the disease.

Crohn's disease

An autoimmune disease affects the gastrointestinal tract, mainly the intestines, and involves the lymphatic vessels and mesenteric nodes. They increase in size, forming large conglomerates. This pathology is treated surgically.

Tumors and developmental anomalies

All neoplasms are divided into malignant and benign. Previously, intestinal mesenteric cysts were classified as tumor-like benign formations. It is currently believed that this is a developmental anomaly.

A mesenteric cyst has thin, easily wounded walls without a muscle layer. Contents: liquid. When the abdomen is injured, the cysts burst and the contents spill into the abdominal cavity.

Benign tumors of dense consistency include lipomas, lymphogranulomatosis, and fibromas. They are usually multiple and often become malignant.

Developmental anomalies include:

• twists;
• nonunion;
• torsions.

When the mesentery is not closed, a loop of intestine penetrates through this defect, and sharp pain develops as a result of strangulation of the intestinal loops. With a diagnosis of “acute abdomen,” patients are placed on the operating table.

All developmental anomalies most often manifest themselves in early childhood.

Malignant neoplasms

The following tumors occur:

• sarcoma;
• endothelioma.

At stages III and IV of small intestinal cancer, the mesentery, its lymph nodes and vessels are affected by the tumor tissue.

There are no specific symptoms for this disease. Existing abdominal pain does not alarm patients. Patients associate bloating with poor diet and seek medical help very late.

The reason for treatment is the development of small intestinal partial or complete obstruction. The diagnosis is made during surgery.

The mesentery is affected in cancer of the large intestine. Metastases from distant organs, including neurogenic tumors, occur.

Metastases occupy a large niche among tumors. This occurs due to the characteristics of blood circulation, the structure of lymphatic vessels and nodes.

More on the topic: How to cleanse the intestines at home?

The lymphatic network of the mesentery collects lymph from all organs of the abdominal cavity: intestines, liver, stomach, pancreas, gall bladder. There are 6 times more lymphatic vessels in the mesentery than blood vessels. The number of lymph nodes reaches 300 - 350. With any pathology of the abdominal organs, including malignant tumors, the mesentery is involved in the process.

Vascular diseases

With pathology of blood circulation in the mesentery, serious life-threatening conditions are noted.

Types of circulatory disorders:

• in the superior mesenteric vein - thrombosis;
• in the superior mesenteric artery - occlusion.

When the mesenteric vessels narrow, ischemia or infarction of the large or small intestine develops.

Causes of strictly circulatory disorders:

1. Atrial fibrillation.
2. Heart defects.
3. Prosthetic heart valves.
4. Vascular atherosclerosis.
5. Increased blood clotting, for example, with long-term use contraceptive drugs.
6. Inflammatory diseases of the abdominal organs.
7. Low blood pressure.
8. Taking cardiac glycosides.
9. Angina pectoris, coronary heart disease.
10. Dehydration.
11. Systemic diseases of connective tissue, accompanied by damage to the walls of blood vessels: systemic lupus erythematosus, hemorrhagic vasculitis, periarteritis nodosa, dermatomyositis, rheumatoid arthritis.

Clinical picture

Severe cramping, sudden pain in the abdomen, first located near the navel. But it spreads very quickly throughout the abdomen, becoming diffuse and permanent. Symptoms of intoxication such as constipation, diarrhea, fever, vomiting, nausea, loss of appetite have no diagnostic value. They occur in all diseases accompanied by intoxication.

When palpating the abdomen, sharp pain and bloating are detected.

Vascular diseases have a catastrophic outcome, as they lead to the death of large areas of the intestine. Gangrene, peritonitis, dehydration, and sepsis develop.

Treatment is surgical, with the exception of systemic connective tissue diseases. In this case, therapy for the underlying disease helps greatly.

Injuries

Mesenteric rupture is a fairly common type of injury.

With open penetrating abdominal trauma, mesenteric ruptures are observed in 20% of cases. When closed - in 25% of victims.

In children (mesadenitis) is a pathological condition that is accompanied by abdominal pain, intoxication, and dyspeptic syndrome. Mostly teenagers and children are affected, and more often boys aged 7 to 13 years.

There are about 600 lymph nodes in the human abdominal cavity. This amount is associated with their important function - they are a barrier to infection.

The causative agents of mesadenitis can be:

The pathogen enters the tissue of the lymph nodes directly from the intestines or through the lymphogenous route (by lymphatic vessels) from a focus of inflammation outside the intestine.

The course can be acute and chronic. For acute course characterized by a sudden onset and pronounced symptoms. The patient becomes capricious and resists examining the abdomen.

Pain is an essential symptom of this disease. She has a constant dull character. The intensity of pain increases with movements and turns to one side. Pain sensations are localized in the navel or epigastrium ( upper part abdomen). It happens that the patient cannot clearly localize the place where it hurts. Here we can talk about the diffuse nature of the pain syndrome.

The pain syndrome is accompanied by a decrease in appetite, the occurrence of hiccups, nausea, and vomiting. Diarrhea or constipation may occur.

The abdomen of such children remains soft. If you put the child on his back, bend his knees slightly and gently, smoothly press the edge of his palm on his stomach, and then sharply remove his hand (a method for checking symptoms of peritoneal irritation), he will not feel any sharp pain. The absence of symptoms of peritoneal irritation is characteristic of mesadenitis.

The disease is accompanied by an increase in body temperature to 39-40 C. Symptoms of intoxication are mild, and the child’s general well-being is practically not affected.

Since the lymph nodes are involved in the pathological process for the second time, the child has symptoms of another disease (ARVI, tonsillitis, bronchitis, pneumonia).

Tuberculous mesadenitis

The causative agent in this case is Mycobacterium tuberculosis. It enters the lymph nodes of the child’s abdominal cavity from the primary site (usually the lungs). The disease begins gradually. The patient becomes lethargic and gets tired quickly. His appetite decreases. He loses weight and becomes pale.

Sweating at night is typical for such children. The pain is minor and is often localized near the navel. The temperature rarely rises above 37-37.2 C. If the diagnosis is not made on time, the lymph nodes become dense and can be palpated through the anterior abdominal wall. Often these children suffer from a cough that cannot be treated with conventional antibiotics.

Such children, as a rule, do not have BCG vaccination or the vaccination schedule is violated. If you carefully conduct a survey in this case, you can establish contact between such a child and a patient with tuberculosis.

In this case, the Mantoux test, x-ray of the chest area and bacteriological examination of sputum will help to make a diagnosis.

Diagnostics

Diagnosis of lymph node pathology includes a number of studies.

1. General blood test - allows you to determine the increase in the level of leukocytes (white blood cells responsible for destroying the pathogenic agent). A decrease in hemoglobin levels may indicate the presence of chronic disease(occurs in tuberculosis).
2. A general urine test will determine the condition of the urinary system. The presence of leukocytes in the urine will indicate an inflammatory process in the genitourinary organs.
3. A coprogram and a test for occult blood in the stool are prescribed to determine the condition of the intestines.
4. A tuberculin test (Mantoux test) is performed if a tuberculous inflammation is suspected.
5. Ultrasound examination (ultrasound) of the abdominal organs will determine the presence of enlarged dense lymph nodes. This method also allows you to determine the condition of the liver, gall bladder, pancreas, and kidneys.
6. Fibrogastroscopy – using thin probe the doctor examines the mucous membrane of the esophagus, stomach and duodenum. If these organs have pathological changes, then it is possible to pinch off a piece of tissue for examination (conduct a biopsy).
7. Fibercolonoscopy uses a thin optical probe to examine the mucous membrane of the colon.

It is mandatory to examine such children for the presence of helminthic infestation (worms can mechanically damage the intestinal wall and maintain chronic inflammation). If using all these methods it is not possible to establish the cause of pain in the child’s abdomen, a blood test for the presence of viruses, computed tomography and MRI of internal organs are performed.

Complications

If you do not seek medical help in a timely manner or if lymph node pathology is treated inadequately, complications may develop.

Treatment

Treatment of children with inflammation of the lymph nodes of this localization is carried out in a hospital setting. Hot, spicy, fatty foods are excluded from the diet. In the acute period, meals are frequent and in small portions. Soups are prepared using vegetable broth.

Lean boiled meat (beef, rabbit, chicken) or cooked in a double boiler is allowed. Fish (boiled or steamed) must be included in the diet. The consumption of low-fat cottage cheese and non-acidic fruits is allowed. After the acute process subsides, nutrition expands.

In the acute period, the patient's physical activity is limited, and quiet games are preferred. Prescribed. In this case, it is necessary to take into account the sensitivity of the pathogen to them.

Detoxification therapy is carried out in order to reduce the manifestations of intoxication and is administered intravenously. medicinal product. If necessary, painkillers are prescribed.

Prevention

Preventive measures are aimed at timely detection and treatment of conditions such as inflammation of the mesenteric lymph nodes in children. Timely implementation preventive vaccinations will help avoid tuberculous mesadenitis.

It makes sense to focus on strengthening the body’s defenses (hardening, herbal tea, physical education, walks on outdoors in any weather). Reducing the incidence of upper respiratory tract diseases serves as secondary prevention of this pathology.