Medical Q&As

Mesenteric adenitis - still in pain?

My 7-year-old son had his appendix removed 2 months ago. The surgeon concluded that the pain was caused by mesenteric adenitis and not an inflamed appendix. My son has recovered from surgery but has continued to have bouts of tummy pain especially after eating. The pain seems to be more frequent and worse recently. Currently his stomach is quite sore on palpitation. What do I do next? What other causes are there? Should the mesenteric enteritis have cleared by now?

Mesenteric adenitis means inflammation of the mesenteric glands, which are located inside the abdomen. Sometimes the level of inflammation and pain associated with this condition can be so severe that it can mimic acute appendicitis. Presumably that is exactly what happened in your sonís case and lead to him undergoing a laparotomy for presumed appendicitis. There are no tests for distinguishing between the two conditions and the true diagnosis is often not apparent until a laparotomy is performed. Mesenteric adenitis can recur and can give rise to recurrent abdominal pain. Other causes of recurrent abdominal pain would include such conditions as constipation, urinary tract infection, irritable bowel syndrome, inflammatory bowel disease, bowel infestation and coeliac disease. However, the commonest category of recurrent abdominal pain in children is described as non-organic, which means that there is no physical cause for the pain. Sometimes children develop recurrent abdominal pain if they are worried or insecure. Bullying can sometimes trigger recurrent bouts of pain. Recurrent abdominal pain can even occur as a symptom of child abuse. I hasten to add that I am not remotely suggesting that this could be the case with your son. I am merely indicating that the aetiology of abdominal pain in a child can be quite complex. It is also important to emphasise that non-organic pain is not imagined or unreal. Non-organic pain can be just as severe as pain of physical origin. I would suggest that you re-attend your GP and have your son re-assessed. Your GP will probably suggest that your sonís urine be tested to exclude the possibility of urinary tract infection. Other than that it is usually not necessary for a child with recurrent abdominal pain to undergo extensive investigation. Most cases subside over time with simple symptomatic measures and encouraging reassurance.