Mesenteric lymphadenopathy in children examined by US for chronic and/or recurrent abdominal pain (original) (raw)
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Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Abdominal pain is perhaps the most common painful health problem in school-aged children. J Apley, a British paediatrician, studied abdominal pain among children extensively and observed that approximately 10% of school aged children get recurrent episodes of abdominal pain. He named this symptom complex as recurrent abdominal pain (RAP) syndrome and defined it as "at least three episodes of abdominal pain, severe enough to affect their activities over a period longer than three months" Pain localization in younger children is poor, and in a suffering child, physical examination is often limited. Thus, sonographic evaluation of the abdomen is frequently performed in children to investigate the reason for the pain and to exclude other acute abdominal surgical conditions. The main clinical concerns are acute appendicitis, intussusception, and torsion of the ovary. With the routine use of high-frequency transducers, detection of enlarged abdominal lymph nodes (EALNs) is very common. When enlarged nodes are found with no other abnormality detected, the term "mesenteric lymphadenitis" is often used to describe an inflammatory process of abdominal lymph nodes. The aim of this study was to evaluate the profile of recurrent abdominal pain in children examined by clinical examination and ultrasonography. MATERIALS AND METHODS We prospectively studied 100 patients within age range from 1 to 16 years and attending paediatric department at Sri Aurobindo
Journal of Pharmaceutical Research International, 2021
Background and Aim: Mesenteric lymphadenitis in pediatric population usually presents with abdominal pain mimicking appendicitis mounting a challenging task for physicians to diagnose. It is a self-limiting inflammatory process and resolves spontaneously. In addition to clinical features, ultrasonography is the primary diagnostic modality. We aimed to evaluate the clinico-radiological characteristics of mesenteric adenitis in patients presenting with abdominal pain. Materials and Methods: A total of 108 patients attending paediatric out-patient and paediatric surgery clinic in Saveetha Medical College and Hospital, Chennai, between January 2018 and December 2020 with abdominal pain for several aetiologies were included in this study. The clinical presentation, laboratory parameters and the ultrasonographic findings were noted. Data summarized as numbers, percentages and Mean ± Standard Deviation (SD). Results: Peak prevalence was found to be at around 8 [range 6-10] years. Clinicall...
The Professional Medical Journal
Objectives: To assess common presenting features of children with abdominalpain and to determine role of High frequency & Doppler Ultrasound in evaluation of thesepatients. Material and Methods: This is a cross sectional study conducted from August 2012 toDecember 2012. Data from patients presenting for evaluation of abdominal pain was analyzed forpresenting complaints and ultrasound findings according to objectives of the study. Results: Intotal 262 cases were included in the study. The mean age of patients was 6.3 years with a male tofemale ratio of 1.47:1. Dysuria followed by Diarrhoea and vomiting were most commonassociated complaints, Urological pathologies were most common ultrasound findings uponevaluation of patients. Conclusions: Abdominal pain is a frequent presenting feature inpeadiatric population, Urological pathologies were most common examination findings.Ultrasound is a useful and safe modality in evaluation of abdominal pain in children.
Mesenteric lymphadenopathy in children with chronic abdominal pain
Sri Lanka Journal of Child Health, 2018
Background: Mesenteric lymphadenopathy is a common finding described by abdominal ultrasonography in children. Objective: To estimate incidence and significance of mesenteric lymphadenopathy (MLN) in children with chronic abdominal pain (CAP) as compared to healthy children. Method: A prospective observational study was conducted in the paediatric department of a tertiary care hospital. Cases included children of age group 5-15 years with CAP who were subjected to abdominal ultrasonography during the study period. Controls included children in whom abdominal sonography was performed for reasons other than abdominal pain. Descriptive statistics were used for the analysis of baseline characteristics of the study group. For the variables following normal distribution curve, mean and standard deviation were computed. The presence of enlarged nodes, their location, size and other significant findings were recorded. Pearson's Chi-square test was used to analyse categorical variables between groups. Results: Three hundred and eighteen children were enrolled in the study. After excluding those who did not meet the criteria, the final study population included 110 cases and 138 controls. CAP was almost equal in both sexes with male: female ratio of 1:1.07. Mesenteric lymph nodes were detected by ultrasonography in 84 (72.1%) cases and in 41 (13.4%) controls. Significant MLN (≥5 mm short axis or >10mm long axis) was present in 62 (56.4%) of 110 children with CAP, in contrast to 16 (11.6%) of 138 controls (p <0.001). Most common location of the nodes was in the right iliac fossa (79%) followed by peri-umbilical location (77.4%).
Recurrent Pain Abdomen Among Children-An Emphasis on Base Line Investigations
Introduction: Recurrent abdominal pain (RAP), a frequent presenting complaint in general practice, first defined by Apley as " episodes of pain occurring at least monthly for three consecutive months with severity that interrupts routine functioning ". Pain is classified as either organic or non-organic, with a plenitude of factors being implicated in genesis. The symptoms tend to be vague and investigations seldom show organic disease. Study was done to determine the causes of RAP in 5-14 years old children visiting the Paediatric OPDs on the basis of baseline tests that includes urine routine examination, stool routine examination and sonography. Material and methods: A total of 112 children with recurrent pain abdomen were enrolled in the prospective observational study. Detailed history was taken following which general and systemic examination was done. Complete blood count, urine and stool routine microscopy and ultrasound abdomen were done. Additional investigations like X-ray chest and abdomen, barium meal study, tuberculin and serological test for tuberculosis were carried out based on their necessity. Patients were categorised into organic and functional (non-organic) groups. Results: Out of 112 children with RAP, 86 were in 5-10 years age group and 26 were in 11-14 years. The site of pain abdomen was categorised as 63 in epigastric region followed by umbilical region and other areas. Among associated symptoms fever and vomiting were present in most of the cases apart from loose stools, constipation, chest pain and burning micturition. Pain in relation to food was observed in 35 children. USG abdomen showed retro peritoneal lymphadenopathy in 4 children and 2 patients were suffering from abdominal tuberculosis. Fifty three children revealed an organic cause from the basic investigations. Conclusions: Baseline investigations can lead to a diagnosis in 47% cases of recurrent abdominal pain in children.
Study profile of recurrent pain abdomen in children examined by ultrasonography
International Journal of Contemporary Pediatrics, 2016
Abdominal pain is a frequent condition in children. Pain localization in younger children is poor, and in a suffering child, physical examination is often limited. Thus, sonographic evaluation of the abdomen is frequently performed in children to investigate the reason for the pain and to exclude other acute abdominal surgical conditions. 1 The main clinical concerns are acute appendicitis, intussusception, and torsion of the ovary. With the routine use of high-frequency transducers, detection of enlarged abdominal lymph nodes (EALNs) is very common. When enlarged nodes are found with no other abnormality detected, the term "mesenteric lymphadenitis" is often used to describe an inflammatory process of abdominal lymph nodes. However, there is some disagreement in the medical literature about the importance of finding EALNs and use of the term "mesenteric adenitis." In the pediatric literature, the term is reserved for specific inflammation of the mesenteric lymph nodes, caused by Yersinia, Staphylococcus, Salmonella, different types of mycobacteria, and viruses. 2-4 In the radiologic literature, the term is mainly applied simply to describe lymph nodes greater than 5 ABSTRACT Background: Abdominal pain is a frequent condition in children, pain localization in younger children is poor, and in a suffering child, physical examination is often limited, thus, sonographic evaluation of the abdomen is frequently performed in children to investigate the reason for the pain and to exclude other acute abdominal surgical conditions. With the routine use of high-frequency transducers, detection of enlarged abdominal lymph nodes (EALNs) is very common. Methods: After approval from ethical committee 50 patients within age range from 1 to 16 years attending paediatric department at BLDE Shri BM Patil medical college hospital Bijapur, Karnataka, India from January 2014 to December 2014 presenting with abdominal pain of various etiological causes subjected to ultrasonographic examination were included in this study. Results: Maximum numbers (46%) of patients are from 5-8 years age group, more number of boys (54%) is affected as compared with the girls. Maximum (62%) patients had total of 1-5 episodes and next infrequency are patients of multiple episodes, 30 % of patients had school loss due to pain abdomen. Right lower quadrant of the abdomen was most commonly affected (30%) followed by left lower (24%) and para-aortic (16%). Conclusions: We can conclude that-EALNs are frequently seen children with pain abdomen 5-8 yrs with girls more commonly affected than boys. Most paeirnts presented with 1-5 episodes, 30 % of patients had school loss due to pain abdomen. Right lower quadrant of the abdomen was most commonly affected (30%) followed by left lower (24%) and para-aortic (16%).
The Approach to Common Abdominal Diagnoses in Infants and Children
Pediatric Clinics of North America, 1998
An original report by Hirschsprung, presented at the Pediatric Congress in Berlin in 1886 and subsequently published in 1887, focused the attention of clinicians on the dilated proximal bowel segment in this This paper, titled "Constipation of the newborn due to dilatation and hypertrophy of the colon," effectively (but incorrectly) guided therapy for over 50 years. This can be seen in Abdominal Surgery of Infancy and Childhood by Ladd and Gross, published in 1941.-The coauthors (ostensibly the Fathers of Pediatric Surgery) noted that the defect was thought to be deficient parasympathetic innervation or overactive sympathetic innervation to the affected (dilated) bowel. Treatment recommendations were parasympathetic stimulants, anal dilatation, cecostomy, local resection of the dilated colon, and total abdominal colectomy (in that order, performed in a total of 39 patients). We now know that all of these recommendations were ill-advised and flirt with disaster because they treated the result of the functional obstruction (the dilated colon) and not the cause.
Clinical and laboratory findings in 220 children with recurrent abdominal pain
Acta Paediatrica, 2011
To investigate the clinical and laboratory findings in children with recurrent abdominal pain (RAP). Methods: Consecutive patients with RAP (Apley criteria), age 4-16 years, referred to a secondary medical centre were evaluated by a standardized history, physical examination and laboratory tests. The tests encompassed Helicobacter pylori (Hp), gastrointestinal bacterial infections, protozoa, coeliac disease, carbohydrate malabsorption, food intolerance, abdominal ultrasound and plain abdominal X-ray. More investigations were obtained if indicated. Patient characteristics were compared with surgical patients without abdominal pain (control group). Results: A total of 220 consecutive patients were included (92 M, mean age 8.8 years [4.1-16.0 years]). In 88% of the patients, abnormalities were found that refer to possible causes. Especially, protozoa were present in 33% of the patients, mostly Dientamoeba fragilis, Yersinia enterocolitica in 12% and endoscopically proven infection with Hp in 11%. In 36%, a plain abdominal X-ray raised suspicion of constipation. Conclusion: In 220 consecutive patients with RAP, referred to secondary care, a standardized work-up yielded abnormal results in a high percentage. The clinical significance of these findings remains to be established.
Emergency Medicine Clinics of North America, 2011
Abdominal pain is one of the most common reasons pediatric patients seek emergency care. The emergency physician must be able to distinguish diagnoses requiring immediate attention from self-limiting processes. Pediatric patients can be challenging, particularly those who are preverbal, and therefore, the clinician must rely on a detailed history from a parent or caregiver as well as a careful physical examination in order to narrow the differential diagnosis. This article highlights several pediatric diagnoses presenting as abdominal pain, including surgical emergencies, nonsurgical diagnoses, and extraabdominal processes, and reviews the clinical presentation, diagnostic evaluation, and management of each.
Abdominal pain in a 7-year-old male
2019
A 7-year-old male presented with abdominal pain of one day duration. An ultrasound (US) diagnosis reported atypical ileocolic intussusception and adjacent hypoechoic nodes, suggesting a possible lead point. Computed Tomography (CT) scan was performed for further investigation ( Figs. 1-2 ). Following a failed fluoroscopic reduction, an ileocolic intussusception was surgically reduced without visible or palpable external macroscopic bowel abnormality. Biopsy of a mesenteric node came back as hyperplasia. Patient’s postoperative US by an inexperienced operator was unrevealing. Four months later the patient presented with abdominal distention and palpable abdominal masses. A repeat CT scan was performed ( Figs. 3-6 ).