MESENTERIC NODE BIOPSY

Mesenteric lymphadenitis often causes abdominal pain. It is most common cause of pain in children and teens.

 

Most common cause is infection, which can be viral or bacterial. In India Tuberculosis has to be ruled out when constitutional symptoms are present.

 

Inflammatory conditions may also be linked with mesenteric lymphadenitis.

 

Much less often, inflamed mesenteric lymph nodes result from cancer, including, Lymphoma or due to metastasis from other areas.

 

Ultrasound (US) or computed tomography (CT)-guided biopsy of intra-abdominal lymph nodes is minimally invasive; however, percutaneous procedures are often difficult to perform because of the location and size of the lymph nodes. In many cases, this approach may result in insufficient specimens necessary to evaluate histopathology. In such cases, laparoscopic biopsy is useful to obtain adequate specimens, regardless of the location and size of the lymph nodes. Additionally, laparoscopic biopsy is an approach that can avoid the possible complications associated with a laparotomy.

 

A patient presenting with intra-abdominal lymphadenopathy is a common scenario, and malignant lymphoma or metastasis from malignancy in other organs is an important clinical consideration. Any nodal enlargement should raise suspicion during laparoscopy and sent for biopsy.

 

Procedure:

  1. A 10 mm supraumbilical port is introduced by Hasson’s technique, so that the specimen can be removed from this port.
  2. 2 other 5 mm ports are used preferably in the Left iliac fossa and suprapubic area targeting the mesentry near Ileocecal region.
  3. On lifting the terminal ileum the mesentry is exposed showing the lymphnodes.
  4. The peritoneum covering the node is incised with cautery to avoid bleeding. The rent is widened for the node to pop out of the rent. The base is held with a Maryland forceps to cauterize the blood supply and node is separated from the rest of mesentry.
  5. Hemoastasis is achieved and the node removed through the 10mm port under vision by changing the camera to a 5 mm port through the left iliac fossa port.

 

Suggested Reading:

 

Masanori Sando, Masaki Terasaki, Yoshichika Okamoto, Kiyoshi Suzumura, Tomonori Tsuchiya The Utility of Diagnostic Laparoscopic Biopsy for Mesenteric and Retroperitoneal Lymph Nodes. Am J Case Rep. 2017; 18: 878–882.

 

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