Comparison of Clinical Findings of Acute Appendicitis and Mesenteric Lymphadenitis in Children with Acute Abdominal Pain

Mesenteric lymphadenitis is an inflammatory process that has similar clinical symptoms to appendicitis among diseases associated with acute abdominal pain. Therefore, the aim of this study was to compare clinical and paraclinical findings in children with appendicitis and mesenteric lymphadenitis.

This cross-sectional study was conducted on 214 children who were admitted to Amirkola Children's Hospital in 2011-2021 with the diagnosis of appendicitis (112 people) or mesenteric lymphadenitis (102 people). Appendicitis and mesenteric lymphadenitis were diagnosed based on pathology and ultrasound, clinical symptoms, laboratory parameters and ultrasound of children were compared in two groups.

Out of 214 children, 112 (52.15%) were girls and the mean age of the children was 7.53±3.19 years. Children with appendicitis compared to children with mesenteric lymphadenitis were more likely to have tenderness (42.2% vs 85.7%, p<0.001), rebound tenderness (40.2% vs 4.9%, p<0.001), vomiting (79.5% vs 61.8%, p=0.004) and pain shift (11.8% vs 25%, p<0.013). Also, WBC (9774.51±3971.35 vs 15358.04±4635.20, p<0.001), neutrophil (63.42±17.05 vs 77.02 ± 10.51, p<0.001), ESR (19.73±18.56 vs 38.57±27.29, p<0.001) and CRP (18.00±27.98 vs 52.77±40.30, p<0.001) were significantly higher in children with appendicitis. Ultrasound sensitivity (0.73-0.88) was 80.4% in diagnosing appendicitis and rejected mesenteric lymphadenitis with 100% probability.

The results of the study showed that some clinical symptoms with leukocytosis, neutrophilia and high CRP can help differentiate appendicitis from mesenteric lymphadenitis. But ultrasound can have a more definitive result in this regard.