A Case of the Mesenteric Lymph Node Abscess that was Difficult to Distinguish from Acute Appendicitis, and Relieved by Percutaneous Drainage

Abstract

A 17-year-old male was admitted to our hospital with the chief complaint of pain in the right lower quadrant abdomen. Physical examination revealed hard tenderness in the right lower quadrant. His body temperature was 38.8°C. Laboratory test results showed a white blood cell count of 14,830 cells/µL and a C-reactive protein level of 0.23 mg/dL. Computed tomography (CT) revealed inflammatory changes and some swollen lymph nodes around the ileocecal region, but not the typical findings of acute appendicitis. We suspected mesenteric lymphadenitis and administered antibiotics to the patient. However, no improvement in clinical findings was observed the next day. With the suspicion of acute appendicitis, we decided to perform an emergency appendectomy. However, intraoperative findings did not show typical findings of acute appendicitis. Pathological findings indicated secondary appendicitis. 5 days after operation, physical findings worsened, and tenderness and rebound tenderness in the right lower quadrant were noted. CT revealed an intraperitoneal abscess. A diagnosis of mesenteric lymph node abscess was confirmed; percutaneous abscess drainage was performed and the antibiotic was changed. The patient was discharged 20 days after hospitalization. This case illustrated the difficulty in distinguishing between acute appendicitis and a rare mesenteric lymph node abscess. Here, we report our experience in treating a patient with a mesenteric lymph node abscess.