Case report on Mesenteric Lymphadenopathy: Unravelling the Enigma of Abdominal Swellings

Dr Maherukh Siddiqui
Abstract:
Mesenteric lymphadenopathy refers to the enlargement of lymph nodes in the mesentery, a fold of tissue that attaches the intestines to the abdominal wall. While often a secondary manifestation of an underlying condition, mesenteric lymphadenopathy can pose diagnostic challenges and necessitates a comprehensive understanding of its aetiology, clinical manifestations, and management. This case report aims to shed light on the scientific intricacies of mesenteric lymphadenopathy, exploring its causes, diagnostic approaches, the implications for patient care and the wonders of homeopathy in its treatment.

4. Introduction: The mesentery plays a crucial role in supporting the intestines and facilitating their function. Mesenteric lymphadenopathy, characterized by the enlargement of lymph nodes within this tissue, is a common clinical finding associated with various diseases. Understanding the underlying mechanisms and clinical significance of mesenteric lymphadenopathy is essential for clinicians to provide accurate diagnoses and effective treatments.
5. Aetiology: Mesenteric lymphadenopathy can be attributed to a diverse array of aetiologies, including infectious, inflammatory, neoplastic, and autoimmune causes. Infections such as tuberculosis and viral enteritis can induce lymph node enlargement, while inflammatory conditions like Crohn’s disease and ulcerative colitis may also contribute. Neoplastic processes, including lymphoma and metastatic cancers, are significant contributors to mesenteric lymphadenopathy. Autoimmune disorders, such as systemic lupus erythematosus, can further complicate the diagnostic landscape.
6. Clinical Manifestations: The clinical presentation of mesenteric lymphadenopathy varies based on its underlying cause. Patients may experience abdominal pain, bloating, altered bowel habits, or even remain asymptomatic. Careful history-taking and physical examination are crucial for identifying potential red flags that may guide further diagnostic investigations.
7. Diagnostic Approaches: Due to the broad spectrum of potential causes, a systematic diagnostic approach is paramount in evaluating mesenteric lymphadenopathy. Imaging modalities such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound play pivotal roles in visualizing mesenteric lymph nodes and assessing their characteristics. Biopsy, either through fine-needle aspiration or surgical excision, is often required for definitive diagnosis, especially in cases where malignancy is suspected.
8. Management: Effective management of mesenteric lymphadenopathy hinges on addressing the underlying cause. Collaborative efforts between gastroenterologists, radiologists, and pathologists are essential for accurate diagnosis and tailored treatment plans. In cases of malignancy, oncological strategies, including surgery, chemotherapy, or radiotherapy, may be warranted.
9. Conclusion: Mesenteric lymphadenopathy poses a diagnostic challenge for healthcare professionals due to its diverse aetiology and variable clinical presentation. A comprehensive understanding of the underlying causes, coupled with advanced diagnostic tools and collaborative multidisciplinary efforts, is crucial for effective management.

CASE REPORT

• P.D NO- 5029/512876
• NAME OF PATIENT- master J
• S/o – Mr. K P
• AGE- 8 years
• SEX- male child
• RELIGION AND CASTE- Hindu
• OCCUPATION- student
• ADDRESS WITH MOBLIE NO.- H. no 1399, abbas nagar, kolar road, Bhopal 8878860XXX

CHIEF COMPLAINTS WHICH IS PURPOSE OF CONSULTATION

• Pain in para umbilical region RECURRING AGAIN AND AGAIN for 4 years
• < after eating, on defecation
• > pressure (from sides)
• Appetite is lost

HISTORY OF PRESENT ILLNESS

• MODE OF ONSET – gradual
• COURSE – insidious
• PROGRESS – static
• TREATMENT ADOPTED – taken allopathic medications
• RESULT – colic is static
• PAST HISTORY – CHILDHOOD TO ADULTHOOD – immunizations timely done.
• colic pain comes and goes
• typhoid fever- 2-3 years back
• No H/o fever . No h/o TB contact.
• FAMILY HISTORY – father –NAD, mother – NAD, siblings – NAD.

PERSONAL HISTORY

• MIND AND DISPOSITION- shy child but cooperative. Aversion to take bathe
• DIET- vegetarian
• DESIRE- sweet
• THIRST- decreased (3-4 glasses/day)
• TONGUE- red and moist
• SALIVATION- normal
• PERSPIRATION- profuse, wets the pillow
• STOOL- normal, sometimes once/2 days
• URINE- normal
• BATHING- aversion++
• COVERING- aversion+
• DWELLING PLACE- pukka house
• APPETITE- decreased (1-2 chapatti/day)
• HABITS / ADDICTIONS- none
• THERMAL REACTION- hot patient
• SKIN- dusky and pale
• SLEEP- sound
• DREAM- not specified
• TENDENCY TO ANY PATHOLOGICAL CONDITIONS- none
• OBSERVATION-
• BEHAVIOUR- co operative
• MODE OF TALKING- answers slowly
• COMPLEXION- dark
• BUILT-lean
• COLOUR OF FACE, EYES AND SKIN- dark complexion with black hairs and eyes
• EXPRESSIONS – of pain on examination

EXAMINATION – GENERAL

• ANAEMIA – present SPo2 – 98%
• JAUNDICE – absent blood pressure – 98/60 mm of hg
• NAILS- pink tonsils – non enlarged, non-tender
• HAIR – black
• NECK VEINS- non palpable cervical, axillary lymph nodes – non enlarged
• GUM – healthy palms – hot to touch
• PUPILS- normal dilation with light reflex
• TEMPERATURE- 38° C
• RESPIRATORY RATE – 24/min
• CYANOSIS – absent
• OEDEMA- absent
• KOILONYCHIA – absent
• NECK GLANDS – non engorged
• TEETH – healthy
• TONGUE – red and moist
• HEARING-sound
• PULSE RATE- 108/min

SYSTEMIC EXAMINATION – ABDOMEN

• INSPECTION – shape – distended
• no scars present
• PALPATION- p/abdomen – soft, mild tenderness over para umbilical region.
• PERCUSSION- no liver dullness
• AUSCULTATION – bowel sounds are normal
• BRIEF EXAMINATION OF OTHER SYSTEMS- CVS – S1 and S2 audible
• Respiratory system – B/L lungs are clear.
•  CNS – conscious and well oriented

LABORATORY INVESTIGATIONS

PREVIOUSLY DONE – USG – 01/11/2021

• multiple sub centric discrete mesenteric lymph nodes with preserved hilar echoes noted, largest approx. 8 *4 mm in short axis
• Mild amount of free fluid in pelvic and peritoneal cavity
• s/o – ascites
• Rest visualised USG abdomen findings are within normal limits.
• LABORATORY INVESTIGATIONS ADVISED – CBC

PROVISIONAL DIAGNOSIS – Mesenteric Lymphadenopathy

• DIFFERENTIAL DIAGNOSIS– ACUTE APPENDICITIS
• Intussusception
• Strangulated hernia

MIASMATIC DIAGNOSIS –

• Scrofulous diathesis arises from “PSORIC CONSTIUTION” YET IT IS GENERALLY UNDERSTOOD THAT IN PSORA WE HAVE NO INVOLVEMENT OF LYMPHATICS, WHATEVER, WHICH IS SO CHARACTERISTIC OF PSORA.
• DISEASE – DISEASES INVOLVING GLANDULAR SWELLINGS.

 PRESCRIBING TOTALITY –

• Pt complaints of stitching pain in para umbilical region for 4 years.
• Pain < after eating, defecation > on applying pressure from sides.
• Appetite is lost
• Mentally, pt is shy yet co operative
• Answers slowly on being questioned
• Pt has aversion to bathing++
• Tongue – red and moist
• Palms are hot to touch
• Perspiration – profuse, wets the pillow
• Thermally hot patient
• Aversion to covering+
• Desire for sweets

ANALYSIS AND EVALUATION – ACCORDING TO DR. J.T. KENT 

• MENTAL GENERALS – mentally, pt is shy yet co operative
• Answers slowly on being questioned
• PHYSICAL GENERALS – appetite is lost
• Pt has aversion to bathing++
• Tongue – red and moist
• Palms are hot to touch
• Perspiration – profuse, wets the pillow
• Thermally hot patient
• Aversion to covering+
• Desire for sweets
• PARTICULARS – Pt complaints of stitching pain in para umbilical region for 4years.
• Pain < after eating, defecation > on applying pressure from sides.

REPORTORIAL TOTALITY – synthesis repertory

• Mind – answering – slowly
• Mind – timidity
• Stomach – appetite – diminished
• abdomen – pain – children, in – school children; in
• Abdomen – pain – umbilicus – region of umbilicus
• Perspiration – profuse
• Generals – bathing – aversion to bathing
• Generals – food and drinks – sweet – desire
• Generals – uncovering – desire for

REPORTORIAL RESULT

• Sulphur – 18/8
• Lycopodium -16/8
• Mercurius – 14/8
• Pulsatilla – 15/7
• Rhus tox – 14/7
• sepia – 14/7
• Calcarea – 13/7
• Bryonia – 14/6
• China – 11/5

FINAL SELECTION OF MEDICINE WITH DISCUSSION –

• Belladonna has been given in first visit – 16/11/21 with no such relief in colic followed by medicine which came in repertorisation as 2^nd

PRESCRIPTION –

• 16/11/21 – Rx
• Belladonna 200
• 4 pills, OD, 3 days
• 20/11/21 – Rx
• Sulphur 200 stat dose
• 4 pills, empty stomach – early morning
• Sac lac 200
• 4 pills, TDS– 7 days

ADVICE – Increase intake of water

• Take balanced diet rich in fibres and nutrients

FOLLOW UP –

15/2/22 – C/o – abdominal pain reduced, occurring occasionally once /4-5 days

> flatulence, pressure

Stool- normal consistency, regular

Thirst – decreased

appetite – normal

Rx

Lycopodium 200

4 pills, HS – 2 doses

Rubrum met 30

3 pills, TDS – 14 days

• 27/4/22 – improvement in previous complaints
• colic episode – once- twice in a month
• thirst – decreased
• appetite – 3 chapatti /day
• O/e – tongue – clean and moist
• scaling of skin of palms < summer
• mentally, aversion to milk
• likes pine apple, mango
• Rx Sulphur 200 – stat dose 4 pills, early morning
• Sepia 30 (start after 3 days)
• 4 pills, OD – 3 days

advice – USG whole abdomen

CONCLUSION –
There is wide range of medicines are available but for cure individualised medicine with removal of underline miasm is required.

This case report is accompanied by photographic evidence along with improvement in patient symptoms.

Declaration of patient consent: parent of the patient was explained about the study and consent was obtained.

ACKOWLEDGEMENT: I am thankful to Dr. Ajay Singh Parihar Professor & HOD Department of Paediatrics, GHMC Bhopal, Madhya Pradesh, for his constant support and guidance.

REFERENCES:

1. Concise Materia Medica of Homoeopathic Medicines. by S. R. Phatak
2. Allens key notes Rearranged and classified with leading remedies of Materia Medica and Bowel Nosodes-H.C Allen, M.D
3. Synthesis homeopathy software

Dr Maherukh Siddiqui
MD -Scholar, Department of Paediatrics
Government Homeopathic Medical College and Hospital, Bhopal

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