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12 year male boy presented with fever and pain abdomen for 5 days., constipation on and off for long time. pain not releieved on giving oral analgesics and oral Antibiotics. on examination 3 scars present on abdomen, appendesectomy done 2 years back. pain is generalised , no guarding / rigidity or point tenderness, no ascites or any other change in shape. USG done, reveals multiple enlarged mesenteric lymphnode measuring 21×12 mm. how to proceed further??

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Concluded answer

it is case of Enteric fever. child responded well to ceftriaxone..

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Fever and pain are acute, so colitis more likely . Mesentric adenitis can be due to this acute inflammation of the colon. A course of ofloxacin an ornidazole/ metronidazole should suffice. Do a thyroid profile for constipation .

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Lymph nodes size is big but less likely TB as only chronic symptom is constipation. No long standing fever , loss of wt I suppose . More likely enterocolitis . Treatment with antibiotics with metrogyl . Find out the cause of constipation & treat accordingly .

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Get investigated on line of tuberculosis i e M T with 5 t u B C G test E S R Igg andIgm specefic for tuberculosis U S G of abdomento rule out tb it is very common cause of such symtoms

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With the history of fever loss of weight it is likely Enterocolitis.

Do CBC ESR typhi antigen malaria antigen urinert lft xray chest Mt CRP then decide biopy HP under usg

Abdomen is like a magic box...Many times we would not know what is in there until it is openned.In recent days U\S abdomen is Significantly helpful..where symptoms dominated with hardly signs. Mesentric adenitis has been increasingly diagnosed these days.Many resolve with or without treatment.Trail of antibiotics Keeping enteric organisms..Bactrim/clinda/ Metrnidadazole is acceptable.If you luxury Of GI/ID/surgical consult if available is not bad idea in difficult cases..but not always needed.

it is case of Enteric fever. child responded well to ceftriaxone..