- Self limiting inflammatory process that affects the mesenteric lymph nodes in the right lower quadrant (RLQ)
- Can mimic and is often misdiagnosed as acute appendicitis
Epidemiology
- Most common in children and young adults
- Males and females are equally affected
Etiology
- Viral
- Bacterial – Yersinia, H. pylori, Salmonella, Shigella, M. tuberculosis
- Fungal
Clinical features
- Similar to acute app – acute onset of peri-umbilical pain that shifts to RLQ
- Tenderness
- Rebound tenderness (Blumberg sign)
- Nausea and vomiting may be present
- White cell count can be normal or elevated
Complications
- Volume and electrolyte imbalance – due to vomiting and diarrhoea
- Abscess
- Ischemic colitis
- Peritonitis
- Sepsis
Investigations
- Ultrasound/CT
- Show enlarged mesenteric lymph nodes in the presence of a normal appendix
- Bloods – leukocytosis
- Serology – to see antibodies against etiologic agent
- In some cases diagnosis is made intra-operatively during procedure for presumed acute appendicitis
Treatment
- Most cases are self limiting over a few weeks
- Broad spectrum antibiotics
- General supportive care
- Surgery indications – abscess, peritonitis, or if acute appendicitis cannot be excluded with certainty