Saturday, March 19, 2016

Treatments for Mesenteric Adenitis

A 5-year-old patient came in last week with severe abdominal pain.  She had a recent history of vomiting multiple times with high fevers for about a week.  She then began experiencing severe, intermittent abdominal pain.  The abdominal pain was so severe that she did not sleep for at least 3 consecutive nights.  This was not helping her symptoms.  She eventually went to the emergency department, in efforts to rule out any major surgical need, or other life threatening situation.

While the in the ER, the patient underwent a series of testing.  She had blood work drawn, urine drawn, a thorough physical examination, an abdominal ultrasound and an abdominal x-ray.  It was determined that the patient was slightly constipated, and that her main cause of severe abdominal pain was due to mesenteric adenitis.  She was sent home with instructions to take ibuprofen for the pain.

Once home, the parents treated the girl with alternating ibuprofen and tylenol. These remedies did not help with the pain at all.  The abdominal pain persisted for many weeks following, without relief with over the counter medications.  The parents were exhausted, as was the girl.  They were wondering if there were better treatments out there for mesenteric adenitis.  That is when they began a web search and could not find anything worthwhile.

This scenario led me to want to research the best treatments for mesenteric adenitis as well, and to quantify and compare the differences between each treatment so that I could give the parents the best, and most accurate information out there.  I then went to PubMed to look up articles that I could put into Treatment Scores.  As it turns out, there are no evidenced based studies on effective treatments for mesenteric adenitis.  In fact, there are few articles that discuss this diagnosis whatsoever.  This led me to realize that we don't actually know what works for treatment.  I was able to then let the parents know that we aren't sure how effective ibuprofen versus Tylenol versus any other over the counter pain medication actually is in treating the disease.

Though I could not find enough information on the treatment of mesenteric adenitis to put into the Star BlocksTM at TreatmentScores.com, I was at least able to explain to the parents of this girl why the ibuprofen may not actually be working to treat her pain, since we have no data to support it's use for this condition.


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