Mesenteric adenitis

This presents a difficult problem in differential diagnosis with acute appendicitis because the history can be very similar. At times the distinction may be almost impossible. In general, with mesenteric adenitis localisation of pain and tenderness is not as definite, rigidity is less of a feature, the temperature is higher, and anorexia, nausea and vomiting are also lesser features. The illness lasts about five days followed by a rapid recovery. Comparisons between the two are presented in Table 30.5 but if in any doubt it is advisable to consider the problem as acute appendicitis and perhaps proceed to laparotomy.

Mesenteric adenitis can sometimes present an anaesthetic risk and patients are usually quite ill in the immediate postoperative period.

Table 30.5 Comparison of the features of acute appendicitis and mesenteric adenitis in children (guidelines only)

Acute appendicitis

Mesenteric adenitis

Typical child

Older

Younger

Shifting to right

Can be midline

Preceding respiratory illness

Uncommon

Invariable: URTI or tonsillitis

Anorexia, nausea, vomiting

+ +

±

Colour

Usually pale

Flushed: malar flush

Temperature

N or T

T T ^ T T T

Abdominal palpation

Tender in RIF Guarding ± rigidity

Tender in RIF Minimal guarding Usually no rigidity

Rectal examination

Invariably tender

Often tender but lesser degree

Psoas and obturator tests

Usually positive

Usually negative

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