Patient's question:
My son is five years old. Since last year, he has frequently complained of stomach pain. At the hospital, an ultrasound revealed swollen mesenteric lymph nodes. He received five days of intravenous drips and took medicine for nearly a month, but his condition did not improve. Could you please ask the expert how this condition should be treated? Additionally, my child often has ulcers on both sides of his mouth. I wonder if this is related to the condition as well? Does this condition affect a child's development? I urgently await your reply. Thank you, expert!Doctor's answer:
Generally believed to be caused by hematogenous infection of streptococcus, it is also thought to be related to intestinal inflammation and parasitic diseases. It is most commonly found in the terminal ileum. The lymph nodes show multiple congestion and enlargement. There may be a small amount of inflammatory effusion in the abdominal cavity. Under the microscope, lymphatic sinuses are dilated, neutrophils enter the sinuses from small blood vessels and phagocytose bacteria. Some white blood cells may undergo degeneration and collapse, forming cell fragments or degenerative substances. The blood vessels within the lymph nodes are also dilated and congested, with hyperplasia of the germinal centers, sinus cells, and immunoblasts.Acute mesenteric lymphadenitis is most common in children under the age of 7. Before onset, there are often prodromal symptoms such as sore throat, fever, fatigue, and discomfort, followed by pain in the umbilical and right lower abdominal areas, nausea, and vomiting. In some cases, diarrhea or constipation may occur. This progression of symptoms is the opposite of acute appendicitis, which typically presents with abdominal pain before fever, and the temperature may rise sharply in the early stages. On physical examination, there may be tenderness in the umbilical and right lower abdominal areas, with a relatively wide range and non-fixed point of tenderness. Due to underdeveloped abdominal muscles in children, abdominal rigidity may not be. Sometimes, small nodular masses can be palpated. The white blood cell count may be elevated or normal. If caused by streptococcus, abdominal puncture may yield thin, greenish fluid, and Gram-positive cocci can be identified on smears.
If the medical history is typical, the range of abdominal tenderness is broad, and there is no abdominal muscle rigidity, non-surgical treatment can be initiated first, such as intravenous antibiotics or the use of heat-clearing and detoxifying agents. Close observation of changes in abdominal signs is necessary. If the condition worsens and it becomes difficult to distinguish from diseases such as appendicitis or Meckel diverticulitis, exploratory surgery with appendectomy is still recommended.