What should adults do if they have inflammation of the lymph nodes in the abdominal cavity?

Lymphadenitis is an acute or chronic disease of the lymph nodes in the mesenteric region of the small intestine. From the first days of development, the disease is characterized by intense dynamics with severe stabbing pains in various places, increased body temperature, shortness of breath and severe nausea. Although the enlarged lymph nodes are concentrated in only one place and resemble a lesion, the pain syndrome is very diffuse, and the patient experiences severe pain throughout the abdomen. To confirm the suspicion of inflammation of the mesentery, a comprehensive examination of the entire body and the gastrointestinal tract organs themselves is carried out. This allows not only to register the inflammatory process in the tissues of the lymph nodes, but also to determine the cause of the disease.

Symptoms of mesadenitis in adults

Symptoms of the disease can be divided into acute and chronic. The latter form of the disease is very rare and its occurrence is the result of an initially incorrect treatment process or, in fact, a lack of treatment.

From the first days of lymphadenitis, the patient experiences the following symptoms:

• Body temperature rises, reaching 37–39 degrees Celsius and largely depends on the activity of the cells of the adult immune system;
• There are sharp and spasmodic contractions in the perianal area, which are aggravated by exercise, heavy lifting, coughing and sudden lifting of the body;
• symptoms of fever with profuse sweating appear when the temperature in the room is generally normal and there are no signs of sweating;
• the heart beats abnormally fast, up to 120 beats per minute (the patient does not move, lies down);
• dyspeptic disorders, manifested by nausea, urge to vomit, dry mouth, heaviness in the stomach and loose diarrhea.

Very rarely, symptoms such as cough, runny nose, herpetic rash on the surface of the lips and pharyngitis appear. In most cases, this is a reaction of the body caused by a significant weakening of the protective function of the immune system due to an attack of the mesenteric lymph nodes. Chronic mesadenitis has similar symptoms, but is less pronounced.

Causes of inflammation

Infection by infectious microorganisms is the main inflammatory factor in the tissue of the mesenteric lymph nodes. These are bacterial, viral or fungal diseases. Based on this, doctors identify the following most common causes of mesenteritis in adult patients:

• A significantly weakened immune system, whose cells cannot provide adequate resistance to biological agents entering the bloodstream and lymphatic system;
• hereditary predisposition to diseases of lymphoid tissue (especially diagnosed in people who have close relatives with a chronic course of the same disease)
• the presence of a constant low-grade inflammatory focus of infectious origin (in such cases, pathogenic microflora enters the tissue of the lymph node through blood or lymph fluid);
• the lumen of the intestinal wall is too thin, which allows bacteria to penetrate into the mesenteric lymph nodes.

They are especially often diagnosed in patients with concomitant diseases of the gastrointestinal tract, such as viral hepatitis, ulcers with symptoms of infection, abscesses and erosions in the intestinal tissue.

Diagnostics and tests

When a patient arrives with corresponding complaints of acute abdominal pain and elevated body temperature, an inexperienced doctor examining the patient cannot always quickly and accurately determine that the person is really in the initial stage. stage of mesenteritis. Especially if the patient also has liquid diarrhea, the presence of which is the first suspicion of an intestinal infection.

To make a correct diagnosis, the patient must undergo the following tests:

• Examination of a surgeon palpating the abdominal surface (with mesadenitis, lumpy nodules form in the navel area, the pressure of which causes even faster contractions);
• Ultrasound diagnostics of the abdominal organs to determine whether the lymph nodes in the mesentery are inflamed or whether the cause of the problem lies in another pathology;
• peritoneal magnetic resonance imaging (an expensive but most accurate research method that allows you to quickly determine which lymph nodes have increased in volume and whether the surrounding tissues and organs have become inflamed);
• venous blood to identify the possible presence of severe infections and other pathological causes of mesenteric lymph nodes;
• blood from a finger for clinical analysis;
• morning urine on an empty stomach, showing the level of sediment, protein and lymphocytes, an increased concentration of which indicates an increase in the inflammatory process.

If necessary, additional gastroscopy is recommended to exclude suspicion of an infectious ulcer, as well as endoscopy of the small intestine.

Enlarged lymph node syndrome as a pediatric problem

The cause of enlarged lymph nodes in most cases is processes not related to hematological malignancies: most often these are general pediatric, infectious, immune and other conditions

The fact that a pediatrician quite often discovers enlarged lymph nodes (LNs) in his patients and he has to quickly find an answer to the questions “why?” and “what to do?”, allows you to do without a long introduction. Thus, when conducting pediatric screening and subsequent analysis of 1607 diagnoses of acute and chronic diseases in children and adolescents aged 5–17 years, it was revealed that lymph node diseases were detected in 3.35% of cases [6]. Traditionally, when enlarged lymph nodes are detected, without taking into account other components of this syndrome (history, general clinical picture, local symptoms), the pediatrician thinks about an oncohematological disease. As a result, such patients make up 40% of all patients of oncohematologists [7], which seems unjustified. The frequency of newly diagnosed cases of oncohematological diseases in our country is low. The incidence of acute leukemia is 4.0 - 5.0 cases per 100,000 children per year, non-Hodgkin's lymphoma - 0.9 - 1.1 per 100,000 children per year. This makes it clear why the overwhelming majority of children with enlarged lymph nodes return from hematologist appointments to pediatricians with a diagnosis of lymphadenitis. That is, the reason for the increase in lymph nodes in most cases is processes not related to hematological malignancies: general pediatric, infectious, immune and other conditions. Based on the above, we decided to present our point of view on swollen lymph node syndrome.

LN enlargement can result from lymphadenitis (LA) and lymphadenopathy (LAP).

LA is an inflammation of the lymph nodes that occurs as a complication after various purulent-inflammatory diseases and specific infections (tuberculosis, actinomycosis, plague, etc.). LA is usually a secondary process.

LAP is a systemic enlargement of lymph nodes, not associated with inflammation (effects of certain medications, proliferation, metastasis, etc.).

The epidemiology of PA and PAP has not been developed. One can only note that, according to I. S. Tarasova [6], in continuous mass studies of children in the Bryansk region, LA occurs, as one would expect, somewhat more often (1.86% among all examined) than PAP (1.49 % of the total contingent).

Methods for studying lymph nodes should be standardized as much as possible. In clinical practice, complaints are assessed (local pain, local or general increase in temperature, general somatic complaints), anamnesis (epidemiological history, duration of onset, localization of enlarged lymph nodes in one or several groups, their simultaneous increase or gradual increase, speed of disease manifestation, etc.) . Examination of the patient is of particular importance. Along with a thorough general pediatric examination by system, it is necessary to pay attention to the number of altered lymph nodes and their location by group. The size of the lymph nodes should be assessed only objectively: in millimeters or centimeters. Comparison of the size of LU with grain, peas, cherries, hazelnuts or walnuts, which is accepted in our country and widely recommended in the domestic literature, is irrational, gives incomparable results and should be eliminated. It is necessary to carefully record the ratio of enlarged lymph nodes to each other. For example, the location of lymph nodes according to the “solar system” type (one large lymph node in the center and on the periphery of it lymph nodes of smaller diameter) is typical for tuberculous lymphadenitis [2]. LNs can be elastic, dense, with fluctuation phenomena. The adhesion of the lymph nodes to neighboring nodes and surrounding tissues, the presence or absence of pain on palpation, must be described. It is necessary to examine and describe the condition of all accessible lymph nodes: occipital, submandibular, anterior and posterior cervical, supra- and subclavian, axillary, elbow, inguinal, popliteal. Inspection and palpation data are supplemented, confirmed and clarified by instrumental techniques. First of all, these are non-invasive imaging methods used to study deep-lying lymph nodes. They allow you to accurately determine the size of lymph nodes, changes in groups of lymph nodes that are inaccessible to inspection and palpation, characteristics of the capsule, adhesion, topographical features, internal structure; exclude conditions simulating lymph node enlargement (tumors not originating from lymph nodes, hematomas, kidney anomalies, etc.). It is extremely important to obtain information about the condition of the liver and spleen. In terms of accessibility and speed of obtaining information, echography (ultrasound) ranks first. LNs with a diameter of less than 1.5 cm are close in density to the surrounding adipose tissue, are rarely visualized, and it is almost impossible to limit their tumor damage from other causes of enlargement only according to ultrasound data. Such lymph nodes are observed primarily in infectious processes, reactive lesions, and in children with hemoblastoses - in a state of complete remission. LNs with a diameter of 1.5 - 2 cm are well visualized if they are projected onto echo-negative structures or change the usual topographic-anatomical relationships. The entire spectrum of ultrasound changes can be reduced to several main groups [3].

1. The enlargement of individual lymph nodes is assessed as small if they do not lose their usual ultrasound picture, retain the capsule, clarity and evenness of the contour, and do not change the topic of the organ. This type is typical for infectious lesions, especially tuberculosis, viral hepatitis, collagenosis, immunodeficiency, hemoblastosis in children at low risk.

2. Further growth of lymph nodes leads to the appearance of masses merging with each other, pushing aside the vessels. It is observed with purulent melting of a group of lymph nodes, with hemoblastosis, metastatic tumors.

3. Compression or pushing aside of internal organs. In this case, hydronephrosis may occur due to compression of the ureters, significant displacement of the uterus and bladder. Typically for extremely unfavorable variants of myeloid leukemia, Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Ultrasound findings can be confirmed by computed tomography (CT). Additionally, CT allows one to clarify the structure of lymph nodes, their topographic relationships, and detect other groups of lymph nodes.

If it makes sense to evaluate superficial lymph nodes only echographically, and mesenteric and retroperitoneal lymph nodes are almost equally well detected by ultrasound and CT, then intrathoracic lymph nodes are detected almost exclusively radiographically.

Diagnostic methods such as isotope scintigraphy and lymphography can be used according to very strict indications in specialized clinics or limitedly in dynamic studies and are not used in widespread practice.

Reliable identification of the causes of lymph node enlargement is possible only by histological methods. In this case, the material should be obtained only by open biopsy of lymph nodes, although modern techniques of fine-needle biopsy make it possible to obtain reliable results. The previously recommended puncture biopsy gives a very high percentage of false-positive and false-negative results.

LN enlargement can be schematically [5, 11] presented (with a description of some practically significant but little-known forms) as associated with infection (IA) and not associated with infection (PAP).

1. LA of viral nature.

• cytomegaly.
• Infectious mononucleosis.
• measles.
• rubella.
• psittacosis.
• Ardmore's syndrome.

An infectious disease, most likely of a viral nature, the peak incidence is observed in the fall, and is transmitted by airborne droplets.
The contagiousness index is high, the incubation period is 3-10 days. It begins with pharyngitis, rhinitis, low-grade fever. It occurs with a generalized enlargement of lymph nodes, a painful enlarged liver (less commonly, splenomegaly), myalgia, and chest pain. Recovery without consequences. 2. LA for bacterial infections.

• caries.
• abscess.
• cat scratch disease. Called Bortanella (Rochalimeae) hensella. More often, bilateral inflammation of lymph nodes (including mesenteric and intrathoracic) with general and skin nonspecific symptoms, which occurs benignly with spontaneous recovery, is caused by skin wounds from cats, dogs, and, less often, from foreign sharp objects. Granulomatous hepatitis, splenomegaly, encephalitic reactions, and convulsive syndrome have been described [8, 10]. It is observed mainly in children and adolescents, mainly in late autumn and winter.
• Borreliosis. Known as pseudolymphoma. Lymphoproliferative lesions of lymph nodes and skin during infection with Borrelia burgdorferi after a tick bite. Transitions to malignant lymphomas have been described.
• Tuberculosis. Along with the typical forms of tuberculosis, one should remember about the so-called. atypical mycobacteriosis. According to F. Miller [2], up to 50% of submandibular lymph nodes in children under 5 years of age are caused by atypical strains of mycobacteria (in particular, the avium type), and the probability of mycobacterial lesion of lymph nodes is higher, the younger the child (Fig. 1).
• Sepsis.
• Allergic subsepsis. It is also considered as a variant of juvenile rheumatoid arthritis, the so-called. Still's disease.
• Syphilis. The rate of increase in the incidence of syphilis in children is significantly higher than that in adults. Thus, the incidence of syphilis among adults increased 15.8 times over 4 years, and among children - 21 times. 65.6% of children became infected through sexual contact [1].
• Genito-anorectal symptom complex is a complication of chronic PA in chlamydia serotypes L1-L3 with periproctitis, chronically recurrent perianal and perineal fistulas, strictures and fibrosis of the genitourethral tract, and elephathiasis of the vulva. It occurs mainly in female patients.

3. LA for fungal diseases.

• histoplasmosis.

4. LA for parasitic diseases.

• echinococcosis.

5. LA for protozoal infections.

• toxoplasmosis. The subclinical variant is cervical subacute necrotizing PA. Clinically - painful, often cervical PA, with spontaneous remission after 3 - 6 months, fever, exanthema. Neutropenia. Histologically - coagulative necrosis with histiocytic and immunoblastic cells without granulomas, without neutrophils. Differential diagnosis is carried out with malignant lymphomas, tuberculosis, histiocytosis, and according to histology (vasculitis) - with systemic lupus erythematosus.
• kala-azar.
• malaria.

Forms not associated with infections (PAP)

1. Medicinal PAWS.

• Hydantoin derivatives (diphenin, etc.) are anticonvulsants. With this complication of therapy, PAP is considered autoimmunoblastic.
• allopurinol (used in the treatment of hyperuricemia, including myeloproliferative conditions).
• anti-leprosy drugs (used in gastroenterology for the treatment of chronic colitis, in rheumatology - for the treatment of arthritis and spondyloarthritis, especially those associated with the histocompatibility antigen HLA B-27).
• post-vaccination.
• against the background of foreign bodies.

2. With systemic processes in the body.

• collagenosis (in this case, the greatest increase in lymph nodes is still recorded in infected variants of diffuse connective tissue diseases, that is, there is a combination of LA and PAW).
• local tumor-like amyloidosis. Traditionally described as a pathology exclusively of adults [4]. However, we found this form of dysproteinosis in 2 of 44 children with systemic amyloidosis. Local tumor-like amyloidosis in our patients occurred with a pronounced general paraspecific reaction, which, in combination with a palpable mass in the abdominal cavity, initially led to an erroneous diagnosis of lymphoma.
• Lubarch amyloidosis, genetically determined. Generalized PAP, orthostatic hypotension, obstructive infiltrative cardiomyopathy, splenomegaly, neuropathy, carpal tunnel syndrome.
• Dorfman-Rosai syndrome (intermittent benign lymphadenopathy). Probably an autoimmune disease with benign proliferation of plasma cells, histiocytes, and fibroblasts. The peak incidence is in the first 10 years of life. It occurs with bilateral cervical, often generalized lymph node enlargement, fever, leukocytosis, erythema nodosum. According to our observations, if internal organs are damaged, the prognosis is poor. The prognosis worsens in the presence of simultaneous immunodysfunction (accelerated ESR, dysproteinemia).
• Leiner's desquamative erythroderma. Most likely, a defect in leukocyte chemotaxis and deficiency of the complement fragment C5. The disease manifests itself in the first 3 to 4 months of life. It manifests itself as a generalized enlargement of all lymph nodes, secondary erythroderma, nail dystrophy, anemia, vomiting, and diarrhea. More common during breastfeeding. Familial cases are known. The prognosis is favorable.

3. Granulomatosis

• sarcoidosis
• allergic granulomatosis Churg-Strauss. Combined with a history of atopy. Manifests itself in the form of bronchial asthma, severe eosinophilia, PAP, neuropathy, skin ulcers, damage to the heart, lungs, intestines and vasculitis of small arteries and veins.
• multicentric reticulohistiocytosis. Systemic granulomatous disease with the formation of skin nodules, destructive arthritis, and damage to internal organs. It proceeds according to the type of psoriatic arthropathy.
• Lipomelanotic reticulosis (Pautrier-Waringer syndrome) is a localized or generalized increase in lymph nodes as an accompaniment of dermatoses, primarily melanoerythroderma.

4. PAW for hemoblastoses.

• acute leukemia.
• non-Hodgkin's lymphomas.
• Hodgkin's lymphoma (according to the old terminology - lymphogranulomatosis).
• alpha heavy chain disease (Mediterranean lymphoma). Observed mainly in childhood and adolescence, the clinic is caused by severe malabsorption syndrome, which is the result of lymphoproliferative processes with infiltration of the small intestine and mesenteric paws.
• gamma heavy chain disease. It is caused by monoclonal gammopathy and occurs as a lymphoproliferative systemic disease.
• histiocytic syndromes

5. LAP in metastasis of solid tumors to lymph nodes.

6. Paraneoplastic reactions [12].

• POEMK complex. Paraneoplastic symptom complex (especially often with sclerosing plasmacytomas) = ​​polyneuropathy + organomegaly + endocrinopathy + dysglobulinemia (M-gradient) + skin lesions.

7. PAP in primary immunodeficiency conditions (PID).

• common variable immune deficiency.
• autoimmune lymphoproliferative syndrome.
• granulomatosis septic. A heterogeneous group of immune defects, united by incomplete intracellular phagocytosis of catalase-positive microbes as a result of deficiency of hydrogen peroxide and atomic oxygen [11]. Currently, 4 different molecular defects are known: a) X-chromosome-linked recessive defect of cytochrome B558 heavy chains; b) autosomal recessively inherited defect of light chains of cytochrome B558; c) defect of 47 kd cytosol factor; d) defect of 65 kd cytosol factor. Clinical signs: acute abscess infections of the skin, lungs, gastrointestinal tract, lymph nodes, liver, spleen caused by catalase-positive bacteria (staphylococci, enterobacteria), as well as aspergillus; chronic granulomatous inflammation in the gastrointestinal tract and urinary tract with possible stenosis; decreased production of atomic oxygen and hydrogen peroxide in response to soluble and opsonized stimuli.

8. Genetically determined PAWS [9].

• Klippel-Trenaunay syndrome. Combination of local lymphangiomas and hemangiomas.
• syndromes with hereditary lymphedema. Wever-Smith and Milroy syndromes.
• pulmonary muscular hypertrophy - muscular cirrhosis of the lung. The proliferation of smooth muscle fibers is perialveolar, peribronchial, interstitial, interlobar. Enlarged lymph nodes at the hilum of the lungs. DD is carried out with sarcoidosis, tuberculosis, pulmonary emphysema, alveolar-capillary block syndromes. The diagnosis is verified only histologically.

9. Acquired immunodeficiency syndrome (AIDS).

In the process of diagnosing diseases that occur with an increase in lymph nodes, the efforts of pediatricians, infectious disease specialists, immunologists, and oncohematologists are combined. The main role in this case is given to the pediatrician, since most PAs and PAPs in children are associated with an infectious process. At the same time, one cannot insist on the infectious genesis of lymph node enlargement if a two-week course of antibiotic therapy did not lead to a significant improvement in the clinical, laboratory and instrumental picture. In favor of the oncohematological genesis of changes in lymph nodes is indicated by an increase in their diameter to 4 cm or more, stony density, tuberosity, formation of conglomerates of lymph nodes, their adhesion to surrounding tissues, intrathoracic conglomerates, especially in the upper mediastinum, intraperitoneal conglomerates.

A clear knowledge of the variety of causes of lymph node enlargement will help pediatricians in the diagnosis and differential diagnosis of this syndrome.
Literature
1. State report on the state of health of the population of the Russian Federation in 1994. M., 1995. p. 43. 2. Miller J. Tuberculosis in children and adolescents. M.: Medicine, 1984. p. 296. 3. Nazarenko O. R. Comparative value of echography in assessing the condition of the abdominal organs in children with acute lymphoblastic leukemia. Author's abstract. dis. ... Ph.D., M., 1997. p. 24. 4. Nikhamkin L. I. Local tumor-like amyloidosis of the mesentery. Archives of Pathology, 1966. 4. p. 76 - 78. 5. Samochatova E.V., Vladimirskaya E.B., Zhestkova N.M., Navolotsky A.V. et al. Hodgkin’s disease in children. M.: Altus. - 1997. 96. 6. Tarasova I. S. Clinical and hematological characteristics of children under various radiation dose loads. Author's abstract. dis. ... Ph.D. M., 1997. p. 25. 7. Chernov V.M., Finogenova N.A., Shakhtalin V.V., Sidorovich G.I. Structure of hematological morbidity of children in the city of Klintsy, Bryansk region. In the book: Medical aspects of the influence of low doses of radiation on the body of children and adolescents. Obninsk - Moscow, 1992. p. 92 - 95. 8. Dangman BC, Albanese BA, Kocia M. Cat scratch disease with fever of unknoun origin: imaging features and association with new causative agent Rochalimea henselae. Pediatrics, 1995. v. 5. p. 767 - 771. 9. Emery A., Rimoin D. Principles and practice of medical genetics. 1988. V. 1, 2. 10. Flexman J. Bortanella henselae is a causative agent of cat scratch disease in Australia. J. Infect., 1995. V. 31. No. 3. p. 241 - 245. 11. Leiber B. Die klinischen Syndrome. Muenchen, 1990, Bdd. 1.2. 12. Siegenthaler W. Differential diagnosis innerer Krankheiten. Stuttgard, 1993. s. 800.

Treatment of inflammation of the lymph nodes in the abdominal cavity in adults

The lymphatic system of an adult person performs many functions, one of them is cleansing the body of pathogenic microflora, represented by bacterial, viral, fungal infections, toxins, parasitic life forms, as well as cells that are free radicals and are a substrate for cancerous tumors. Therefore, in case of inflammation of the lymph nodes of the abdominal cavity and the development of mesadenitis, several areas of treatment are used to treat the disease. Let's look at each of these techniques in more detail.

Diet

This method of treating the disease consists of compiling the patient’s diet from the following products:

• kefir, rice, sour cream, curdled milk, curdled milk;
• Cereal porridge seasoned with a small amount of oil;
• Light vegetable salads seasoned with herbs and low-fat oil;
• compote of rose hips, dried fruits and sweet berries;
• boiled chicken meat;
• fresh fruit or baked in the oven;
• blueberry or milk jelly;
• vegetable soup with added cereal;
• chicken soup.

Fried, smoked, fatty and spicy foods should be excluded from the menu. Food should be divided so as not to overload the digestive tract. Meals should be taken 5-6 times a day, but in small portions.

Medication

Drug treatment is based on the patient's clinical picture. The most effective medications for mesadenitis are divided into the following categories:

• broad-spectrum antibiotics effective against a specific strain of infection;
• Antiviral drugs if the cause of the disease is infection of the lymph nodes by a virus;
• a complex of vitamins and minerals that strengthens the immune system;
• antispasmodics to relieve acute pain.

The above pharmacological groups can be administered in the form of intramuscular injections or tablets. If there is no positive therapeutic effect from pharmacological treatment, and the clinical picture of mesenteric inflammation worsens and abscesses form, the surgeon decides to remove the damaged tissue.

Folk remedies

Traditional medicine offers its own recipes for getting rid of inflammation of the mesentery. Prepare the following anti-inflammatory herbal remedy:

1. Take 5 grams (1 teaspoon) of dried herbs such as chamomile, St. John's wort, thyme, sycamore, and thyme and place them in a metal bowl.
2. The resulting mixture of herbs should be thoroughly mixed until a homogeneous mixture is obtained.
3. Pour 1 liter of running water and place on the stove.
4. Bring to a boil, reduce gas and simmer for another 15 minutes.
5. Turn off the pan and let the broth cool.

After the natural anti-inflammatory remedy for mesadenitis has cooled, strain it through a sieve or cheesecloth to remove any plant particles. The decoction is taken 5 times a day, 150 grams on an empty stomach. Duration of therapy is 10-15 days.

Introduction

Various mesadenitis is a relatively rare pathology, which presents certain difficulties for diagnosis, especially in urgent surgery when acute abdominal syndrome occurs. The pain syndrome caused by mesadenitis imitates destructive appendicitis, peritonitis or acute gynecological pathology [1-4]. In addition to verifying mesadenitis as the cause of a surgical emergency, it is necessary to establish its etiological factor. This task can be assigned to the surgeon by a therapist, oncologist, hematologist or any other specialist. The variety of etiological factors and the unclear pathogenesis of the development of mesadenitis, the lack of specific signs and uniform diagnostic criteria significantly complicate the diagnosis and treatment of this syndrome [5-7].

The first classification of mesadenitis was proposed in 1926 by A. Wilensky and L. Hahn, who divided mesenteric lymphadenitis into nonspecific (catarrhal and purulent) and specific (tuberculous). According to the course of the disease, Brown (1929) described the subacute and recurrent forms, and Rosenburg (1937) introduced the concept of the fulminant form. The most complete classification of the syndrome of enlarged lymph nodes was developed by V.M. Timerbulatov et al. (2009) [8]. Most acute mesadenitis occurs in pediatric practice [4]. In the adult population, chronic and subacute mesadenitis becomes more important against the background of bacterial and viral infections, HIV infection, tuberculosis, metastatic screenings or lymphoproliferative diseases [5, 9, 10]. Other causes of mesadenitis in adults are much less common. Numerous sources of literature indicate the polyetiology of mesenteric lymphadenitis in patients with HIV-positive status; a significant amount of time passes before the diagnosis is verified; unfortunately, in some cases, the cause of damage to the mesenteric lymph nodes is established postmortem [9, 10].

Due to the nonspecific clinical picture, noninvasive and minimally invasive imaging methods play a key role in verifying the diagnosis. Thus, according to most researchers, ultrasound has high sensitivity and specificity in the diagnosis of space-occupying and inflammatory diseases of the abdominal organs. Affected mesenteric and retroperitoneal lymph nodes are determined in the form of enlarged, more than 1.2-1.5 cm, round formations with impaired differentiation of the cortical and medulla layers with an anechoic structure in the center (with abscess formation); it is often possible to visualize reactive effusion (free fluid) in abdominal cavity [11, 12].

The most informative method for differential diagnosis of tumor and inflammatory changes in the abdominal organs is multislice computed tomography (MSCT). With this technique, enlarged, more than 10-25 mm in diameter, lymph nodes of a heterogeneous structure are visualized (due to peripheral contrast enhancement and/or zones of low density), and compaction of the perinodular tissue adjacent to the affected lymph node is also characteristic. With intravenous contrast, tuberculosis is characterized by accumulation of contrast agent along the periphery of the lymph node, while its central part, filled with caseous masses or liquid exudate, does not accumulate contrast agent [13, 14]. Radiation diagnostic methods, as a rule, make it possible to visualize enlarged lymph nodes, but not to establish the etiological factor, which is necessary for further treatment. Laparoscopy is the most accurate and valuable method for diagnosing lesions of the mesenteric lymph nodes, allowing for differential diagnosis with other urgent diseases of the abdominal cavity in acute abdominal syndrome. In addition to visual assessment of the structure and localization of altered lymph nodes, MSCT provides the opportunity to perform a targeted needle or forceps biopsy and aspirate the exudate present in the abdominal cavity for laboratory tests [1, 2, 15, 16].

The purpose of this work is to analyze the possibilities of videolaparoscopy with lymph node biopsy for mesadenitis in HIV-positive patients.

Complications and consequences in the absence of proper treatment

When mesadenitis develops into a complication, it is a dangerous pathology of the lymphatic system that threatens the patient’s life with the following negative consequences:

• Transition to chronic form;
• catastrophic decrease in the protective functions of the immune system;
• a lymph node abscess that needs to be removed surgically;
• rupture of the abscess capsule with release of purulent contents into the abdominal cavity;
• acute peritonitis with inflammation of the intestines and other organs near enlarged lymph nodes;
• entry into the bloodstream of infectious microbes causing mesenteritis and sepsis.

The latter complication in most cases ends in death. The negative consequences of the disease can be prevented by early pharmacological, surgical or prophylactic treatment that prevents the development of mesadenitis.

What are the reasons?

Among the infections that can cause mesadenitis in a child are bacteria such as:

• coli;
• staphylococci;
• streptococci;
• salmonella;
• Mycobacterium tuberculosis.

These may also be the following viruses:

• enterovirus;
• adenovirus;
• Epstein-Barr virus;
• cytomegalovirus.

Doctors often associate the development of mesadenitis in children with the presence of diseases such as:

• pneumonia;
• flu;
• Infectious mononucleosis;
• tonsillitis;
• bronchitis.

After severe infectious diseases, a child is often diagnosed with reactive mesadenitis. In addition, this pathology often occurs in children as a specific reaction to vaccinations or uncontrolled use of certain types of medications.