Abstract
A 14-year-old boy had suffered from abdominal pain, vomiting, and diarrhea. We diagnosed him as having gastroenteritis at first, but high-grade fever and elevation of white blood cell counts lasted for 5 days. Abdominal pain became worse. Hydrothorax and ascites appeared. Antibiotics were not effective. From clinical findings and computed tomography, a strangulated ileus was suspected. A laparotomy was performed 5 days after admission, which revealed that almost the entire small intestine was edematous and inflammatory. In particular, the terminal ileum was swollen and red. We performed biopsy of the terminal ileum and swollen mesenteric lymph node. Pathological diagnosis revealed histiocytic necrotizing lymphadenitis (HNL). His symptoms and laboratory data significantly improved after the operation. He was discharged after 13 days of hospitalization. We experienced a case of HNL-associated mesentery in a child. As differential diagnosis, we must consider strangulated ileus as the disease.
