Abdominal pains/mesenteric lymphadenitis?

Question

Dear members of the team,
I have a girl (nine years old) diagnosed at the age of 9 months with cystic fibrosis. My daughter has a mild pulmonary disease and pancreatic insufficiency. She receives a "standard" treatment for cystic fibrosis (mucolytic agents, pancreatic enzymes, vitamins and antibiotics when needed). In the last week my daughter complained of abdominal pains, especially in the right lower abdomen region. She had no fever, nausea, vomiting, diarrhea or respiratory infection in the last month. There were two ultrasounds performed and my doughter was consulted by three pediatricians and surgeons. Ultrasound showed that liver, pancreas, gallbladder, kidney, appendix were normal. There were found just few enlarged lymphnodes on the mesenter. Coprological examination and Giardia antigen - negative. Other investigations were not performed. Doctors established the diagosis of mesenteric lymphadenitis and they prescribed only a symptomatic treatment (Trimebutine maleate, Drotaverinum, Ibuprofen). But these medications are not helpful. My daughter still has abdominal pain, especially in the evening and during the night.
Because I am not confident that the correct diagnosis was established, I would like to ask you what other investigation I could do in order to establish with certainty the diagnosis.
If the diagnosis will be confirmed, I would like to ask if this prescribed symptomatic treatment is correct and sufficient. As I said, after a week my daughter still has strong abdominal pains. May antibiotics be helpful in this case?
Thank you.

Answer

Dear Questioner
There are a wide range of causes of abdominal pain in CF. There are reviews on this subject available. Here are two examples you might look at for more information:
J M Littlewood. Abdominal pain in cystic fibrosis. Journal of Royal Society of Medicine 1995; 88(Suppl 25): 9–17 [available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC1295053/pdf/jrsocmed00061-0011.pdf]


Chaudry G et al. Abdominal manifestations of cystic fibrosis in children. Pediatr Radiology 2006; 36(3): 233-40 [available at: www.springerlink.com/content/yr2622r276511686/fulltext.pdf]


If your daughter still has symptoms of pain you should consult your CF clinician for further consideration of the problem.

Best wishes
Stuart Elborn

17.12.2010

The answer is edited by: Prof Stuart Elborn