설사를 동반한 장간막 림프절염 환아 증례 보고

정지호,오지은,이해자,박은정,Jung, Ji-Ho,Oh, Ji-Eun,Lee, Hai-Ja,Park, Eun-Jung 대한한방소아과학회 2008 대한한방소아과학회지 Vol.22 No.3

Objectives : The purpose of this study is to report a case of nine-year-old female pediatric patient who had diagnosed as mesenteric lymphadenitis with abdominal pain. Methods : The patient was treated by acupunture (acupoint: Hegu(LI4), Zusanli(S36), Zhongwan(CV12), Tianshu (S25)), indirect moxibustion and herb medicine (Koakhyangjeonggisan-kamibang, Jakyakgamchotang Ex) for one week. We observed clinical progress. Result and conclusions : After oriental medical treatment, symptoms of mesenteric lymphadenitis (day and night abdominal pain, diarrhea) were improved. This study showed that oriental medicine can be a meaningful treatment for mesenteric lymphadenitis. For more accurate studies, further treatment cases would be needed.

소아 급성 복통 환자에서 외과적 복증과 장간막 림프절염의 임상적 고찰

유정석,홍정미,장진근,차성호 경희대학교 2006 慶熙醫學 Vol.22 No.1

Purpose: Acute appendicitis (AP) and mesenteric lymphadenitis (ML) in children is difficult to distinguish because of similar to clinical symptoms and physical examinations, and non-specific findings. The purpose of this study is to find out useful clinical symptoms and signs to differentiation of AP and ML, and to know usefulness of abdominal sonography in children with acute abdominal pain. Methods: This retrospective study included 185 patients under 18 years old who visit Hanil General Hospital and Kyunghee University Hospital with acute abdominal pain and examined with abdominal sonography from Jan. 2004 to Dec. 2005. Patients were divided 4 groups; group A was ML without associated diseases, group B was ML with associated diseases, group C was AP, group D was other diseases neither ML nor AP. Results: Group A were 63 patients, group B were 22 patients, group C were 79 patients, group D were 21 patients. The incidence was most prevalent in 6~10 years old both group A and group C. The mean age were 114.2±50 months, 127.1±51.3 months in ML group and AP group respectively. The prevalence of ML was 55% in males and 45% in females. The prevalence of AP was 58% in males and 42% in females. The site of abdominal pain was most frequent in right lower abdomen all of group A, group B and group C. Right lower abdominal tenderness and rebound tenderness were more frequent in acute appendicits group than mesenteric lymphadenitis group (P<0.05). There was no statistical significance in clinical symtoms such as fever, nausea, vomiting and constipation, but recent history of upper respiratory tract infection was more frequent in mesenteric lymphadenitis group than acute appendicitis group (P<0.05). Associated diseases of group B showed five patients of acute gastroenteritis, four patients of acute pharyngotonsillitis, two patients of pneumonia, two patients of intussusception, one patient of tuberculous enteritis, meckel's diverticulum and omphalomesenteric duct cyst, acute otitis media, chronic pyelonephritis, pelvic inflammatory disease, ovarian cyst, urinary tract infection, aseptic meningitis each. In acute appendicitis group, the mean white blood cell's count was more higher than mesenteric lymphadenitis group and was more frequent in 15,000/㎣ over. ESR and CRP values were more high in acute appendicitis group than mesenteric lymphadenitis group (P<0.05). The mean sizes of mesenteric lymph nodes were 10.6±3.7mm(5~21.7mm), 11.3±4.5mm(3~18mm), 9.l±2.5mm(4.5~12.9mm) in group A, group B and group C, respectively, but there was no statistical significance in sizes. Abdominal sonography and computed tomography for detecting acute appendicitis had a positive predictive value of 93.5% and 100%, respectively. Group D showed seven patients of acute gastroenteritis, three patients of acute pyelonephritis, two patients of functional gastrointestinal disease, two patients of pelvic inflammatory disease, one patient of ovarian teratoma torsion, ovarian cyst, intussusception, cystitis, constipation, Henoch-Schlein purpura, diverticulitis each. Pathways of visit in hospital was most prevalent in emergency department all of group A, group B and group C and admission in hospital was most prevalent in department of surgery both group A and group C. Conclusions: AP and ML were frequent in children with acute abdominal pain. The white blood cell count, ESR and CRP values were more higher in AP than ML. Right lower abdominal tenderness and rebound tenderness were more frequent in AP than ML. Abdominal sonography was useful in differential diagnosis between AP and ML and other associated diseases. In children who visited to the hospital for acute abdominal pain, if patients have either right lower quadrant tenderness or rebound tenderness by physical examinations, then check for white blood cell count, ESR and CRP. High level of white blood cell count, ESR and CRP may means possibility of severe acute surgical abdomen or other associated diseases. Further differential diagnosis work-up should be taken such as abdominal sonography because of it's very fast, safe, cost-effective, non-invasive and high accuracy detecting for AP and ML, and detecting for other associated diseases such as ovarian cyst, ovarian torsion, pelvic inflammatory diseases and so on. In mesenteric lymphadenitis confirmed by abodominal sonography, If patients have sustained abdmonial pain, try to find out possibility of other associated diseases.

소아 장간막 림프절염의 임상적 고찰

박철한,이동훈,김혜림,박지민,황진복,김흥식,이희정 대한소아과학회 2004 小兒科 Vol.47 No.1

급성 비특이성 장간막 림프절염의 임상 소견과 급성 충수돌기염과의 감별 인자

신경화,김갑철,이정권,이영환,감신,황진복,Shin, Kyung Hwa,Kim, Gab Cheol,Lee, Jung Kwon,Lee, Young Hwan,Kam, Sin,Hwang, Jin Bok 대한소아소화기영양학회 2004 Pediatric gastroenterology, hepatology & nutrition Vol.7 No.1

Purpose: Although acute nonspecific mesenteric lymphadenitis (ANML) is probably common cause of abdominal pain in children, which can be severe enough to be an abdominal emergency, the clinical features of mesenteric lymphadenitis are not clear. Also, a differential diagnosis with acute appendicitis (APPE) is indispensable to avoid serious complications. The clinical features of ANML were determined, and the risk factors for differential diagnosis with APPE were analyzed. Methods: Between November 2000 and May 2001, data from 26 patients (aged 1 to 11 years) with ANML and 21 patients (aged 2 to 13 years) with APPE were reviewed. ANML was defined as a cluster of five or more lymph nodes measuring 10 mm or greater in their longitudinal diameter in the right lower quadrant (RLQ) without an identifiable specific inflammatory process on the ultrasonographic examination. There were risk factors on patient's history, physical examination, and laboratory examination; the location of abdominal pain, abdominal rigidity, rebound tenderness, fever, nocturnal pain, the vomiting intensity, the diarrhea intensity, the symptom duration, and the peripheral blood leukocytes count. Results: Of the 26 ANML patients and 21 APPE patients, abdominal pain was noted on periumbilical (76.9% vs 14.2%), on RLQ (11.5% vs 71.4%), with abdomen rigidity (7.6% vs 80.9%), with rebound tenderness (0.0% vs 76.1%)(p<0.05), in the lower abdomen (11.5% vs 14.2%), and at night (80.8% vs 100.0%) (p>0.05). The clinical symptoms were vomiting (38.4% vs 90.4%), the vomiting intensity ($1.5{\pm}0.7$ [1~3]/day vs $4.5{\pm}2.9$ [1~10]/day), diarrhea (65.3% vs 28.5%) (p<0.05), and fever (61.5% vs 76.2%)(p>0.05). The period to the subsidence of abdominal pain in the ANMA patients was $2.5{\pm}0.5$ (2~3) days. The laboratory data showed a significant difference in the peripheral blood leukocytes count ($8,403{\pm}1,737[5,900{\sim}12,300]/mm^3\;vs\;15,471{\pm}3,749[5,400{\sim}20,800]/mm^3$)(p<0.05). Discriminant analysis between ANML and APPE showed that the independent discriminant factors were a vomiting intensity and the peripheral blood leukocytes count and the discriminant power was 95.7%. Conclusion: The clinical characteristics of ANML were abrupt onset of periumbilical pain without rigidity or rebound tenderness, a mild vomiting intensity, normal peripheral leukocytes count, and relatively short clinical course. If the abdominal pain persist for more than 3 days, and/or the vomiting intensity is more than 3 times/day, and/or the peripheral leukocytes count is over $13,500/mm^3$, abdominal ultrasonography is recommended to rule out APPE. 목 적: 급성 비특이성 장간막 림프절염(acute nonspecific mesenteric lymphadenitis, ANML)은 타 질환이 적절히 배제되었을 때 임상적 추정으로 진단하는 경우가 많아 그 실체에 대하여는 잘 알려져 있지 않다. 특히 급성 충수 돌기염(acute appendicitis, APPE)과의 감별에 혼란을 주어 복막염 등으로 이행되는 경우가 드물지 않다. ANML의 임상 소견을 보고하고, 특히 APPE와의 감별시 도움을 줄 수 있는 접근 방식을 연구하고자 한다. 방 법: 2000년 11월부터 2001년 5월까지 대구시 한영한마음연합소아과의원으로 급성 복통을 주소로 내원하여 ANML로 진단된 26명(남녀비 13:13)을, APPE 환자는 같은 기간 대구가톨릭대학병원을 방문하여 수술받은 21명(남녀비 12:9)을 대상으로 하였다. ANML 환자들은 복부 초음파 검사상 10 mm 이상, 5개 이상의 장간막 림프절이 관찰되면서 회장, 대장의 장벽 비후 소견이 5 mm를 넘지 않고 염증성 충수돌기가 관찰되지 않으며, 말초 혈액 검사, 소변 검사, 대변 검사상 타 질환을 의심할 소견이 없는 등을 진단기준으로 설정하였다. 결 과: 1) ANML군의 진단 당시 연령은 1~11세, $5.2{\pm}2.3$세였다. 2) ANML군의 복통 양상은 21례(80%)에서 야간 복통이 있었고, 위치는 배꼽 주위부 20례(76%), 우하복부 3례(11%), 하복부 3례(11%)였다. 2례(7%)에서 복부 강직이 있었고, 반발 압통은 전례에서 없었다. APPE군에서는 전례에서 야간 복통이 있었고, 17례(80%)에서 복부 강직이, 16례(76%)에서 반발 압통이 관찰되어 ANML군과 각각 유의한 차이를 보였다(p<0.05). 3) ANML군에서 복통의 회복까지 걸린 시간은 2~4일, $2.5{\pm}0.5$일이었다. 4) ANML군 10례(38%)에서 구토를 보였고 1~3회/일, $1.5{\pm}0.7$회/일이었다. 설사는 17례(65%)에서 있었고 1~4회/일, $1.6{\pm}0.8$회였다. APPE군 19례(90%)에서 구토가 있었으며 1~10회/일, $4.5{\pm}2.9$회로 ANML군과 유의한 차이를 보였다(p<0.05). APPE군의 설사는 6례(28%)에서 있었으며 1~5회/일, $2.1{\pm}1.6$회이었다. 5) ANML군에서 열은 19례(73%)에서 있었고, 말초혈액 백혈구 수는 $5,900{\sim}12,300/mm^3$이었으며 평균 $8,403{\pm}1,737/mm^3$이었다. APPE군에서는 열은 16례(76%)에서 관찰되었으며 백혈구 수는 $5,400{\sim}20,800/mm^3$으로 평균 $15,471{\pm}3,749/mm^3$이었으며 ANML군과는 유의한 차이를 보였다(p<0.05). 6) 판별분석을 이용하여 하루 구토의 강도와 백혈구 수를 독립변수로 하였을 때 ANML과 APPE는 95.7% 수준으로 분류되었다. 결 론: ANML과 APPE의 감별 시 복부강직, 반동압통 등 급성복증의 소견이 의심될 때 뿐만 아니라, 복통이 3일을 초과하여 지속되거나, 하루 구토가 3회를 초과하는 경우, 말초혈액검사상 백혈구 수가 $13,500/mm^3$ 이상을 보일 때에도 반드시 복부초음파 검사를 이용하여 APPE를 확인하여야 한다.

여름철 무균성 뇌막염 환자의 복통과 장간막 림프절염의 연관성에 관한 연구

김혜림,구기영,이영환,감신,황진복 대한소아과학회 2004 小兒科 Vol.47 No.6

장간막 림프절염으로 발현된 Kikuchi-Fujimoto병 1예

최원섭,이승순,권진우,이영석,김선영,전선영,김민정,정두련 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

Kikuchi-Fujimoto 병은 주로 경부 림프절을 침범하는 질환이지만, 드물게 회맹부 장간막 림프절을 침범하여, 발열을 동반한 우하복부 통증과 반발압통을 나타내는 장간막 림프절염을 일으킬 수 있다. 급성 충수돌기염과 유사한 양상의 급성 복증을 호소하는 젊은 성인의 경우, 장간막 림프절염 여부를 확인하여야하며, 그럴 경우 Kikuchi-Fujimoto 병을 감별 진단에 포함시켜야 한다. 저자 등이 경험한 장간막 림프절염으로 발현된 성인의 KikuchiFujimoto 병 1예는 국내에서는 최초로 발견된 것이기에 문헌 고찰과 함께 보고하는 바이다. Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a benign, rare, self limitimg disease presenting with mainly cervical lymphadenopathy and fever unresponsive to antibiotics or medical treatment. A 28-year old man presented with fever and right lower quadrant abdominal pain. Physical examination showed abdominal tenderness and rebound tenderness mimicking acute appendicitis. Imaging studies showed normal appendix and other abdominal organs except enlarged multiple mesenteric lymph nodes. Symptoms persisted despite antimicrobial therapy. Multiple tender lymph nodes were palpable on bilateral cervical area at the 7th hospital day. The biopsy of the neck node showed large areas of patchy, irregular necrosis with prominent nuclear debris surrounded by T lymphocytes, histiocytes without neutrophils and granuloma, so he was diagnosed as Kikuchi- Fujimoto disease. With conservative management, clinical improvement was observed. We suggest that Kikuchi-Fujimoto disease with mesenteric lymphadenitis should be added to the differential diagnosis of acute abdomen mimicking acute appendicitis in young adults.

장중첩증의 임상적 고찰

허유창(Yu Chang Hur),이환봉(Whan Bong Lee),박길수(Gil Soo Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.6

N/A One hundred cases of intussusception who were treated by surgical intervention at the department of general surgery. Eul Ji General Hospital, Seoul from 1987 to 1993 were reviewed. The majority of patients(84.0%) were under 1 year of age, and more than half were between 3 and 5 months. Male to female sex ratio was 3: 1. The most frequent symptom was abdominal pain(89.0%). Duration of symptom between 13 and 24 hours was most frequent(31.0%). Pathologic leading point was identified only in 16 patients(16.0 %) and mesenteric lymphadenitis was the most common one. Ileocecal type was most fre- quent. In the method of operations, manual reduction was performed in 83.0% of cases, and bowel resection and anastomosis was performed in 14 cases. The causes of bowel resection were presence of leading points(10 cases), bowel gangrene(3 cases) bowel per- foration during the attempt of barium enema reduction(1 case). Absence of intuss usception suggested spontaneous reduction at laparotomy was noted in three cases(3.0%). Post operative complications were present in 8 cases(8.0%) and there was no postopera- tive mortality. Delayed surgical intervention could necessitate bowel resection and pro- longed hospitalization. Accordingly a prompt decision for celiotomy or not should be made, after air enema or barium enema trial as indicated.(Korean J Gastroenterol 1994; 26: 919 924)

후천성면역결핍증후군 환자에서 발생한 Mycobacterium avium Complex에 의한 장간막 림프절염 1예

박정호,유호성,신종희,김세종,신동현 대한감염학회 2002 감염 Vol.34 No.4

Primary tuberculosis appendicitis with mesenteric mass

So-Hyun Nam,Jin Soo Kim,Ki Hoon Kim,Sung Jin Park 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.4

Tuberculosis primarily affecting the appendix is extremely rare and the diagnosis is difficult. Here, we report the case of a 14-year-old healthy boy presenting with right lower quadrant abdominal pain. On computed tomography, the distended appendix with 3.3 × 2.7 cm mass located at the right side of the right iliac artery was detected. There was neither bowel wall thickening nor active lung lesion. After laparoscopic appendectomy with mass excision, histopathological examination revealed chronic granulomatous inflammation, with caseous necrosis of the appendix. We made a diagnosis of primary tuberculosis of appendix and administrated anti-tuberculosis medication.