No abstract available.
Mesenteric Lymphadenitis*

No abstract available.
Mesenteric Lymphadenitis* ; Yersinia pseudotuberculosis* ; Yersinia*

No abstract available.
Mesenteric Lymphadenitis* ; Yersinia pseudotuberculosis* ; Yersinia*

Mesenteric lymphadenitis due to Yersinia enterocolitica infection is not common in Korea. Although most cases of Yersinia enterocolitica-induced mesenteric adenitis are self limited, cardinal features of Yersinia enterocolitica-induced mesenteric adenitis are so similar to those of acute appendicitis that some of the patients undergo laparotomy with suspected appendicitis. The findings on laparotomy in such patients are usually enlarged mesenteric nodes with a normal or slightly inflamed appendix. Because histologic examination of the removed mesenteric lymph nodes reveals reactive hyperplasia in most cases, it is usually difficult to suspect Yersinia enterocolitica infection on morphology of the resected nodes. But suppurative granulomata of mesenteric lymph nodes, uncommonly encountered in Yersinia enterocolitica infection, strongly suggest yersinial infection. We report a case of mesenteric lymphadenitis in a 10-year-old boy, who underwent laparotomy with suspected acute appendicitis. The removed lymph node showed several suppurative granulomata in the cortex, suggesting yersinial infection. Serologic study confirmed Yersinia enterocolitica serotype O:3 infection.
Appendicitis ; Appendix ; Child ; Humans ; Hyperplasia ; Korea ; Laparotomy ; Lymph Nodes ; Lymphadenitis ; Male ; Mesenteric Lymphadenitis* ; Yemen ; Yersinia enterocolitica* ; Yersinia*

PURPOSE: The correlation between sonographic findings and clinical symptoms was investigated in the patients with mesenteric lymphadenitis who had recurrent acute abdomen. MATERIALS AND METHODS: Seventy-eight children with recurrent acute abdominal pain without obvious primary disease were evaluated by sonography. The initial and follow-up sonography were performed in 17 children. The abdomen was divided into 3 areas. The number and size of mesenteric lymph nodes were observed in each zone, and was compared with the clinical findings. RESULTS: In 56(71.8%) of 78 cases, good correlation was seen in the area of the greatest size and number of the lymph nodes in the sonography. Most severe symptom, was seen in the right lumbar area(49 cases) and umbilical area(7 cases). In 17 cases of follow up, 14 cases showed decrease size and number of mesenteric lymph nodes while 2 cases showed increase in size and number of the nodes with aggravated symptoms. CONCLUSIONS: Ultrasonography was useful to detect and localize the enlarged mesenteric lymph nodes. Initial and follow-up sonography showed good correlation between the changes in number and size of the lymph nodes and symptoms.
Abdomen ; Abdomen, Acute* ; Abdominal Pain ; Child* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mesenteric Lymphadenitis* ; Ultrasonography*

BACKGROUND: As preoperative diagnosis of acute appendicitis is sometimes difficult, various diagnostic modalities are used for accurate diagnosis. The aims of this study were to define the diagnostic parameters of ultrasonographic (USG) examination and to evaluate the diagnostic efficacy of clinical scoring system in the patients with suspected acute appendicitis. METHODS: A consecutive 130 patients, admitted under impression of acute appendicitis, were underwent routine ultrasonographic examination (from December 1994 to July 1995), and analyzed the accuracy rate of ultrasonographic examination. Already applied diagnostic score (age> or =50 yrs; 1.5, steady pain in right low quadrant; 2, pain relocation to RLQ; 2, tenderness in RLQ; 2.5, rebound tenderness; 2.5, rigidity; 1, Rovsing sign; 2, Rosenstein sign; 2, and leukocyte> or =10,000/mm3; 1.5) in these same patients also analyzed for correlation with final diagnosis and ultrasonographic examination retrospectively. In the second prospective study (from August 1995 to December 1995), 102 patients were enrolled, and diagnostic scoring system was evaluated for the applicability in diagnosis of appendicitis. RESULTS: Of ninety-nine operated patients (clinical and sonography suggested appendicitis), 93 patients (94%) were confirmed as a acute appendicitis, and remaining 6 patients (6%) revealed mesenteric lymphadenitis and 31 patients were discharged without operation. Accuracy of the ultrasonographic examination was 91% of sensitivity, 86% of specificity, and 90% of accuracy rate, respectively. Diagnostic score (>10 point) of these patients revealed also a sensitive parameter in diagnosis of acute appendicitis with 94% of sensitivity, 71% of specificity, and 86% of accuracy rate. In the second prospective study, 85 patients (97% of 88 cases) with diagnostic score over 10 points had been confirmed as a acute appendicitis and only two cases (14% of 14 cases) having below 10 points in diagnostic score needed appendectomy. Over 10 ponits of diagnostic score in diagnosis of appendicitis revealed 98% of sensitivity, 80% of specificity, 96.5% of positive predict value, 85.7% of negative predict value, and 95% of accuracy rate, and relative risk 4.89 (p=0.000). Using multivariate analysis, age (> or =50 years),diagnostic score (> or =10), diameter of appendix (> or =6 mm) in USG, and Rovosing sign were significant independent factors in the diagnosis of acute appendicitis. CONCLUSION: Our results suggest that ultrasonographic examination is necessary in patients with low diagnostic score (<10) to avoid negative laparatomy, but patients with high diagnostic score (>10) can be operated without ultrasonographic examination.
Appendectomy ; Appendicitis* ; Appendix ; Diagnosis ; Humans ; Mesenteric Lymphadenitis ; Multivariate Analysis ; Prospective Studies* ; Retrospective Studies* ; Sensitivity and Specificity ; Ultrasonography

Tuberculosis primarily affecting the appendix is extremely rare and the diagnosis is difficult. Here, we report the case of a 14-year-old healthy boy presenting with right lower quadrant abdominal pain. On computed tomography, the distended appendix with 3.3 x 2.7 cm mass located at the right side of the right iliac artery was detected. There was neither bowel wall thickening nor active lung lesion. After laparoscopic appendectomy with mass excision, histopathological examination revealed chronic granulomatous inflammation, with caseous necrosis of the appendix. We made a diagnosis of primary tuberculosis of appendix and administrated anti-tuberculosis medication.
Abdominal Pain ; Adolescent ; Appendectomy ; Appendicitis ; Appendix ; Humans ; Iliac Artery ; Inflammation ; Lung ; Mesenteric Lymphadenitis ; Necrosis ; Tuberculosis

PURPOSE: Acute abdominal pain in an epidemic aseptic meningitis which is mostly an enterovirus as causative agent, is noted in 23-55% of patients. An enterovirus is also known as one of the causes of acute nonspecific mesenteric lymphadenitis(ANML). The purpose of this study was to see if ANML was associated with acute abdominal pain in epidemic aseptic meningitis. METHODS: Between June 2001 and July 2001, data from 30 patients, aged 3 years to 14 years, with aseptic meningitis was reviewed. Abdominal ultrasonography was performed on all the patients and ANML was defined as a cluster of five or more lymph nodes measuring 5 mm or greater in their longitudinal diameter in the right lower quadrant with no identifiable specific inflammatory process. RESULTS: The clinical symptoms of the 30 patients were:fever(76.7%), vomiting(90.0%), diarrhea(20.0%) and abdominal pain(40.0%). The average peripheral blood leukocytes count on admission was 7,996+/-2,701(4,500-14,500)/mm(3). ANML, according to the ultrasonography, was shown in 93.3% of aseptic meningitis patients; the number of mesenteric nodes was 9.2+/-5.3(5-20), with 7.4% of the 27 control cases being mesenteric nodes positive(P<0.05). The patients with ANML were divided into two groups; those with and without abdominal pain, 42.9% and 57.1% respectively. Two patients without ANML showed no abdominal pain. The count of mesenteric nodes was not significantly correlated with the duration to diagnosis, with or without fever, peripheral blood leukocytes count, and with or without abdominal pain. CONCLUSION: ANML is presumed to be a cause of the acute abdominal pain in epidemic aseptic meningitis. Further clinical observations are recommended on the reason why ANML can be associated with and without abdominal pain.
Abdominal Pain* ; Diagnosis ; Enterovirus ; Fever ; Humans ; Leukocytes ; Lymph Nodes ; Meningitis ; Meningitis, Aseptic* ; Mesenteric Lymphadenitis* ; Ultrasonography

The incidence of abdominal tuberculosis is decreasing due to more effective chemotherapy and pasteurization of milk and tuberculosis may nt be given serious consideration, especially when the primary pulmonary site is healed or not roentgenographically apparent. The clinical features of these infection are relatively nonspecific and the combination of abdominal mass, weight loss, anorexia and fever frequently lead to an erroneous primary diagnosis of neoplasm, especially lymphoma or carcinoma, metastatic to mesenteric lymph node. We have recently experienced a case of abdominal tuberculosis with huge tuberculous mesenteric lymphadenitis simulating neoplasm in 24 month old male. The case was reported with the brief review of literatures.
Anorexia ; Child, Preschool ; Diagnosis ; Drug Therapy ; Fever ; Humans ; Incidence ; Lymph Nodes ; Lymphoma ; Male ; Mesenteric Lymphadenitis* ; Milk ; Pasteurization ; Tuberculosis* ; Weight Loss

PURPOSE: To evaluate the sonographic features of mesenteric lymphadenopathy in childhood epidemic aseptic meningitis and to assess their clinical significance. MATERIALS AND METHODS: Thirty-three patients (25 male, 8 female; mean age, 8.6 years) with a diagnosis of aseptic meningitis were prospectively evaluated with abdominal ultrasonography for the presence of enlarged mesen-teric nodes. The size and number of enlarged mesenteric lymph nodes were analyzed in relationship with the pa-tient's age, between the patients with abdominal pain or diarrhea (16 cases, 48%) and asymptomatic patients(17 cases, 52%). RESULTS: Mesenteric lymphadenopathy was seen in 31 patients (94%), all 16 symptomatic and 15 of the 17 asymp-tomatic patients. The number of enlarged nodes was most prevalent between 6 -10, seen in 16 patients (52%) and the largest node ranged in size from 4 to 8 mm. Among the 31 patients with mesenteric lymphadenopathy, the mean size of the largest node was statistically different between the symptomatic (6.0 mm) and asympto-matic (5.0 mm) groups (p = 0.021). The number of enlarged nodes and the patient's age were not statistically d-ifferent between the two groups. CONCLUSION: Mesenteric lymphadenopathy was seen in almost all cases of childhood epidemic aseptic meningitis, and may be related to the mesenteric lymphadenitis caused by enterovirus.
Abdominal Pain ; Diagnosis ; Diarrhea ; Enterovirus ; Female ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Male ; Meningitis, Aseptic* ; Mesenteric Lymphadenitis ; Prospective Studies ; Ultrasonography*