The child got mesenteric lymphadenitis and didn't get well after taking medicine for more than a month. What should I do?

Suggestion: mesenteric lymphadenitis is one of the common causes of abdominal pain in children, which is easily confused with acute appendicitis in clinic. More common in children under 7 years old. Most of them are viral infections in winter and spring, often complicated with acute upper respiratory tract infection or secondary intestinal inflammation. Typical symptoms are fever, abdominal pain and vomiting, and sometimes diarrhea or constipation. Epidemiology: There are more boys than girls in clinical reports, especially in winter and spring, which are often complicated with upper respiratory tract infection or intestinal infection, with a gradual increase trend. Reason: The terminal lymphatic drainage of ileum is abundant, and there are many lymph nodes in ileum and large intestine. After upper respiratory tract infection or intestinal infection, viruses, bacteria and their toxins reach the lymph nodes in this area along the blood circulation, causing mesenteric lymphadenitis. The patients with virus infection showed mesenteric lymph node hyperplasia, edema and congestion, but the culture was negative. Mesenteric lymphadenitis caused by salmonella infection is different from viral lymphadenitis. The lymph nodes invaded by bacteria mostly show acute inflammatory reaction, bleeding and necrosis, and Salmonella can be isolated from the lymph nodes. Pathogenesis: mesenteric lymph nodes in children are distributed along mesenteric artery and its arterial arch, which is very rich. Because of the function of ileal valve, the contents of ileum and ileum, especially small intestine, often stay at the end of ileum, so intestinal bacteria and virus products are easily absorbed into ileal lymph nodes there, causing mesenteric lymphadenitis. Laboratory examination: White blood cells can increase normally or slightly after onset. Pathological manifestations are lymph node hyperplasia, edema and congestion, but culture is often negative. Urine routine and urine routine are normal. Other auxiliary examinations: ultrasonic examination showed that the abdominal mesentery was thickened, and many mesenteric lymph nodes with different sizes were found, mostly located in the right lower abdomen, with smooth and complete appearance, clear boundary between cortex and medulla, low echo, uniform internal echo and a small amount of fluid dark area in abdominal cavity. It can also distinguish acute appendicitis, pelvic inflammatory disease and ovarian diseases. Clinical manifestations: Typical manifestations are sore throat, fatigue, discomfort, followed by fever, abdominal pain, vomiting, and sometimes diarrhea or constipation after upper respiratory tract infection. About 20% of sick children have swollen neck lymph nodes. Abdominal pain is the earliest symptom of this disease, which can be anywhere. However, because the lesion mainly invades a group of lymph nodes in the terminal ileum, it is common in the right lower abdomen. Abdominal pain is not fixed in nature and can be manifested as dull pain or spasmodic pain. Children feel better between pains. The most sensitive tender parts of each physical examination may be different. Tenderness is near the midline or on the high side, which is not as fixed as acute appendicitis. Compared with acute appendicitis, tenderness is mild, and there is little rebound pain and abdominal muscle tension. Occasionally, a small nodular tumor with tenderness can be palpated in the right lower abdomen, which is mesenteric lymph node enlargement. Some patients may be complicated with intestinal obstruction, which should be observed. Children with similar symptoms to appendicitis in clinic, but with mild condition and no abdominal muscle tension, should consider that acute mesenteric lymphadenitis can obviously improve their abdominal pain after treatment such as fasting, intravenous infusion and antibiotics, and no surgical treatment is needed. However, appendicitis and appendicitis are sometimes difficult to distinguish, and those who have not improved after treatment and observation should be explored surgically. Complications: itself is often a complication of upper respiratory tract infection, because children often vomit and eat less, so water and electrolyte disorders are common; Some patients may be complicated with intussusception and intestinal obstruction. Diagnosis: Acute mesenteric lymphadenitis should be considered when the child has fever, abdominal pain and vomiting accompanied by upper respiratory tract infection or intestinal inflammation. Characteristics of this disease: 1. Most of them are upper respiratory tract infection or intestinal infection complicated with fever, abdominal pain and vomiting. 2. Abdominal pain is usually paroxysmal and spastic, accompanied by right lower abdominal pain, while rebound pain and abdominal muscle tension are rare. 3. Abdominal tenderness can change with the change of body position. 4. Ultrasonic examination showed that mesenteric lymph nodes were enlarged. 5. The diagnosis of this disease should be differentiated from acute appendicitis, intestinal peristalsis, intestinal ascaris and other acute abdomen. 6. After anti-inflammatory and antiviral treatment, the prognosis is good. According to our experience, the possibility of acute mesenteric lymphadenitis should be considered in children with upper respiratory tract infection or intestinal infection with high fever and abdominal pain. Early abdominal B-ultrasound examination can make a definite diagnosis, prevent misdiagnosis of diseases, help to correctly handle the disease, guide the treatment and improve the curative effect. Differential diagnosis: The diagnosis of acute mesenteric lymphadenitis still needs to exclude abdominal pain caused by intestinal peristalsis and intestinal ascariasis. 1. Acute appendicitis has similar symptoms, but acute mesenteric lymphadenitis is mild and the onset is slow. Typical appendicitis children have metastatic pain in the right lower abdomen, fixed tenderness and rebound pain in the right lower abdomen, and the total number of white blood cells and neutrophils in abdominal muscles increases. 2. The onset of tuberculous mesenteric lymphadenitis is slow. In addition to abdominal pain and fever, there are often symptoms of tuberculosis poisoning such as night sweats, emaciation and loss of appetite, accompanied by tuberculosis infection in other parts. Tuberculin test or tuberculosis antibody is helpful for identification. 3. Infectious mononucleosis can also appear mesenteric lymphadenopathy, but it is often accompanied by cervical lymphadenopathy and splenomegaly. It is helpful for diagnosis to check the titers of abnormal lymphocytes, cold agglutinin and EB virus. Treatment: If it has been diagnosed, it can be treated conservatively. General abdominal pain can be obviously improved and gradually recovered after fasting, intravenous infusion and antibiotic treatment, without surgical treatment. However, if the symptoms are not improved after the above treatment, or it is difficult to distinguish them from acute appendicitis, surgical exploration is appropriate. If patients with salmonellosis have symptoms of abscess or peritonitis, surgical drainage should be performed. Some children may be complicated with intussusception, which should be observed. Gastroenteritis is the most common gastrointestinal disease caused by salmonella infection, and acute mesenteric lymphadenitis has also been reported. Mesenteric lymphadenitis caused by salmonella infection is different from viral lymphadenitis, which is more common in children or adolescents. Bacterial invasion of healthy lymph nodes is mostly manifested as acute inflammatory reaction, bleeding and necrosis of lymph nodes, and Salmonella can be isolated from lymph nodes. Conservative treatment should be given first. If abscess or peritonitis symptoms appear, surgical drainage should be performed. Prognosis: Very good. Most of them can recover without any special treatment. Death is rare, and it can only happen when there are secondary specific bacterial infections (suppuration caused by hemolytic streptococcus, abscess caused by lymph node rupture and peritonitis). Prevention: Most viral infections of mesenteric lymphadenitis are usually complicated by acute upper respiratory infection or secondary to intestinal inflammation. Therefore, we should pay attention to prevent colds and fever and pay attention to the diet.