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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 113-117

Nonspecific mesenteric lymphadenopathy in children and its management through Ayurveda: Two case reports


Department of Kaumarbhritya, Government Ayurved College and Hospital, Bilaspur, Chhattisgarh, India

Date of Submission08-Jun-2020
Date of Acceptance10-Dec-2020
Date of Web Publication18-Jan-2021

Correspondence Address:
Dr. Vidya Bhushan Pandey
Senior HIG 3, New Housing Board Colony, Torwa, Deorikhurd, Bilaspur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JACR.JACR_34_20

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  Abstract 


Nonspecific mesenteric lymphadenopathy is one among the leading causes of cumbersome abdominal colic in children. The severity of the pain is variable and may cause emergency hospitalization in most of the cases. In Ayurveda, these complaints simulate with characteristics of Gulma (~abdominal mass or lump) where vitiated Vata dosha is responsible for clinical picture. Two cases of similar presentation of abdominal pain due to mesenteric lymphadenopathy are presented here. Ayurveda drugs such as Lavana bhaskara churna, Trikatu, Kanchanara guggulu, and Kumaryasava B have a textual indication for Gulma and administered along with Jahar mohra pishti, Panchamrita parpati, and Vidanga lauha. These were well tolerated by both the children. Treatment continued for 180 days. The pain was assessed with Wong-Baker Face scale (WBF scale) and Face, Leg, Activity, Cry, and Consolability scale (FLACC scale) according to the age group. After treatment, WBF scale showed a 2/10 score which was 8/10 before treatment and the FLACC scale showed a 0/10 score after treatment which was 10/10 before treatment. Relief in clinical symptoms was found, and the ultrasonography reports had shown improvement in the underlying pathology.

Keywords: Abdominal colic, Gulma, Lavana bhaskara churna, nonspecific mesenteric lymphadenopathy


How to cite this article:
Pandey VB. Nonspecific mesenteric lymphadenopathy in children and its management through Ayurveda: Two case reports. J Ayurveda Case Rep 2020;3:113-7

How to cite this URL:
Pandey VB. Nonspecific mesenteric lymphadenopathy in children and its management through Ayurveda: Two case reports. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Apr 16];3:113-7. Available from: http://www.ayucare.org/text.asp?2020/3/3/113/307219




  Introduction Top


Nonspecific mesenteric lymphadenitis is a common cause of abdominal colic in children, adolescents, and young ones. It is called nonspecific because no underlying cause is present behind this colic, rather some lymph nodes are found inflamed in the mesenteric area.[1] Previously, these enlarged lymph nodes were considered due to tuberculosis; however, as the medical science got advanced, various other causes have been identified, which are responsible for mesenteric lymphadenitis.[1] These reasons might be due to the presence of some diseases, and lymphadenitis is secondary to these diseases.[2] These illnesses include inflammatory bowel disease, appendicitis, enteric fever, certain infections, tuberculosis, malignancy, HIV infection, etc.[2] In spite of these secondary causes, nonspecific mesenteric lymphadenitis remains intact as a separate entity and prevalent between 2% and 14% in young ones and adult population.[2]

Other than abdominal pain, fever ranging from 38°C to 38.5°C and abdominal tenderness will also associate with the disease.[1] Males are slightly more affected than females and is more common in the first decade of life for the reason of abdominal colic.[1] Ultrasonography (USG) is the best tool to identify mesenteric lymphadenopathy.[1]

In Ayurveda, various diseases are explained in the texts which are related to abdominal colic as major complaints. These diseases are Gulma (~abdominal mass or lump), Grahani (~irritable bowel syndrome), Udara roga (~ascitis), Tuni (~intestinal colic), Pratituni (~renal colic), Anaha (~abdominal distension), etc.[3]

Among these diseases, the characteristics of Gulma such as Granthi aneka vidhana (~nodular presentation) and Pindita shavtishthite (~feeling of round mass) are very close to the characteristics of nonspecific mesenteric lymphadenopathy.[4] Two such cases of abdominal colic are presented here along with their sonographic presentation, suggestive of mesenteric lymphadenopathy and their Ayurvedic management.


  Case Report Top


A 3-year-old male child with colic abdominal pain diagnosed to be suffering from mesenteric lymphadenopathy visited the outpatient department. The pain often becomes severe in character and was not associated with any other disease. On examination, mild tenderness was observed over the right lower quadrants of the abdomen. The patient was advised for sonography of the whole abdomen, which presented having mildly enlarged lymph nodes seen in the mesentery of the right iliac region. The largest node was measured 16 mm × 9 mm.

The second case was an 8-year-old girl presented with a similar complaint of abdominal pain with often increased severity. This case also reported occasional mild fever. Less interest in eating foods was also present as an associated symptom. On examination, mild tenderness was observed in the right iliac region on deep pressure. The patient was advised for sonography (whole abdomen) which revealed mesenteric lymphadenopathy.

Both the patients were from low socioeconomic backgrounds. No family history was seen and developmental history was also normal in both cases. Details of their USG reports are mentioned in [Table 1].
Table 1: Ultrasonography reports in both the cases

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  Timeline Top


Ayurveda drugs were administered orally in both cases. Keeping in mind the Vaya (~age), Agni (~digestive fire), Koshtha (~bowel), Bala (~power), Prakruti (~constitution), Ritu (~season), and Satmya (~habituation)[5] of the patients, dose of the drugs was fixed. Details of comparative timeline of both cases and drugs treatment are given in [Table 2] and [Table 3].
Table 2: Comparative timeline of both the cases

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Table 3: Details of the Ayurveda drugs used in the treatment

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Assessment scale

Two different scales were used for evaluation of the clinical findings. For the first case, the boy who was three years old, Wong-Baker Face (WBF) scale was used as this is applicable for the pain evaluation in children aged three years and below.[6] For the second case, the pain scale used was Face, Legs, Activity, Cry, Consolability (FLACC) scale, which is used to evaluate pain in the children aged above three years.[6]

Treatment was continued for 180 days. Assessment was done in a gap of one month. The patient was allowed to take emergency medicine as prescribed by their consulting allopathic physicians.


  Follow-up and Outcome Top


After taking the treatment for six months, pain was still present in Case 1. However, the grading (severity) came down to 2 from 8. However, the pain in Case 2 was subsided after the treatment [Table 4]. All other clinical features were subsided by the end of the treatment.
Table 4: The assessment score in both the cases

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  Discussion Top


Aniyat vipul anu vedanasch (~variability of abdominal pain, some time severe, some time lesser) is the symptom of Gulma related to its Vataja type.[7] In the same way, Acharya vagbhata has mentioned the characteristic of Sparshoplabhya (~feeling of something on palpation) for Gulma, which is related to the finding of tenderness on palpation examination.[8] Acharya charaka also mentioned the locations of abdominal pain related to the Gulma, which are Hridya (~near heart, hypochondrial region), Nabhi (~around umbilical region), Parshva (~below and along the sides of ribs the lumbar and iliac region), Udara (~abdominal or epigastric region), and Basti (~urinary bladder or hypogastric region).[9] This shows that the location of pain is more diversified and shifting in nature; similarly, modern concept also specifies shifting of the tenderness location.[10] Most of the characters are related to Vataja type of Gulma; however, the redactors of Ayurveda mentioned that no Gulma can happen without Vataja dosha; hence, treatment must be planned for the pacification of Vata dosha.[11]

Grahani due to its intestinal location is considered as a closest deferential diagnosis. Other diseases such as Udara roga, Tuni, Pratituni, Anaha, Asthila, and Pratishila though included in deferential diagnosis have dissimilar causative factors and deferent locations of the disease. Keeping these factors in mind, drug protocol was maintained focusing on Gulma having Lavana bhaskara churna followed by Panchamrita parpati to pacify intestinal pathology.[12],[13] Jahar mohra pishti was used as Nirvishikrit (~detoxifying) drug as it is recommended in the treatment of gastrointestinal tract.[14],[15] Trikatu, the mixture of three drugs Pippalli (Piper longum Linn.), Shunthi (Zingiber officinale Rosc.), and Maricha (Piper nigrum Linn.) in equal quantity, acts as Yogavahi drug. Piperine which is the main component extracted from Maricha and Pippalli enhances the bioavailability of the drugs.[16] Vidanga lauha was used because of having Shula prashamana (~anticolic action) property.[17]

Kanchanara guggulu was added as it pacifies Granthi (~tumor or nodule) in Gulma.[18] Kumaryasava B is known to be useful in gastric diseases, especially in children.[19] Lavana bhaskara churna, Trikatu, Kanchanara guggulu, and Kumaryasava have an active role in the management of Gulma.[12],[18],[19],[20],[21]

Vata dosha predominance in Gulma was pacified by the Lavana rasa of Lavana bhaskara churna.[22] Abdominal pain in Case 1 shows relief [Table 4] and [Graph 1]. Improvement in other clinical features along with improvement in the status of lymphadenopathy after 157 days is visible in sonography [Table 1]; however, the treatment was continued for 180 days. Case 2 presented complete relief in abdominal pain [Table 4] and [Graph 1]; other clinical features are also reduced after 180 days of treatment. No abnormality was found in sonography [Table 1].



In both the cases, the focus was kept on addressing the vitiated Doshas and clinical features which became quite clear after looking over USG reports. The report in the first case reveals that the patient was toward the healing pathology and the second case showed complete relief [Table 1]. This reflects that a minimum of 180 days of treatment is required for the management of underlying pathology. No untoward effects of the drugs were seen in both cases during the course of treatment.


  Conclusion Top


The above discussion reflects the utility of Ayurveda drugs in the pacification of clinical features and underlying pathology, i.e., nonspecific mesenteric lymphadenopathy in children. In Ayurveda, the mentioned symptoms are close to Gulma which occurs predominantly due to Vata dosha. Discussed drugs have the potential to manage elevated Vata dosha. Hence, it can be hypothesized that nonspecific mesenteric lymphadenopathy in children simulates Gulma in its clinical features and underlying pathology and can be well managed by the long course treatment minimum of 180 days.

Declaration of patient consent

The authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Helbling R, Conficconi E, Wyttenbach M, Benetti C, Simonetti GD, Bianchetti MG, et al. Acute nonspecific mesenteric lymphadenitis: More than “No need for surgery”. Biomed Res Int 2017;2017:9784565.  Back to cited text no. 1
    
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Maconi G, Radice E, Parro GB. Mesenteric lymphadenopathy. In: Maconi G, Porro GB, editors. Ultrasound of the Gastrointestinal Tract. Medical Radiology (Diagnostic Imaging). Berlin, Heidelberg: Springer; 2007. p. 11-8.  Back to cited text no. 2
    
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Gupta A, editor. Commentary Vidyotini on Ashtanga Hridaya of Vagbhata, Nidana Sthana. Ch. 11. Ver. 58-62. 1st ed. Varanasi: Chaukhaba Prakashan; 2008. p. 357. Reprint 2008.  Back to cited text no. 3
    
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Tripathi BN, editor. Commentary of Charak Chandrika on Charaka samhita of Agnivesha, Nidana Sthana. Ch. 3. Ver. 6. 1st ed. Varanasi: Chaukhamba Surbharti Prakashan; 2005. p. 605. Reprint 2005.  Back to cited text no. 4
    
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Do VQ, Pham TN, Dinh HT, Do XT, Le HT, Nguyen OT, et al. Assessment of Pain in children hospitalized in the Emergency Department, Vietnam National Children Hospital. Pediatr Ther 2017;7:3.  Back to cited text no. 6
    
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Sharma H, editor. Commentary Vidyotini on Kashyap samhita, Chikitsa Sthana. Ver. 10. 1st ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2008. p. 112.  Back to cited text no. 7
    
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Gupta A, editor. Commentary Vidyotini on Ashtanga Hridaya of Vagbhata, Nidana Sthana, Ch. 11. Ver. 38. 1st ed. Varanasi: Chaukhaba Prakashan; 2008. p. 354. Reprint 2008.  Back to cited text no. 8
    
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Tripathi BN, editor. Commentary Charak Chandrika on Charaka samhita of Agnivesha, Nidana Sthana. Ch. 3. Ver. 15. 1st ed. Varanasi: Chaukhamba Surbharti Prakashan; 2003. p. 611. Reprint 2005.  Back to cited text no. 11
    
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Tripathi BN, editor. Commentary Dipika on Sharangdhar samhita, Madhyam Khand. Ch. 6., Ver. 140-6. Varanasi; Chaukhamba Surbharti Prakashan; 2004. p. 191.  Back to cited text no. 12
    
13.
Anonymous. Panchamrit Parpati. In: Essential Drugs List (EDL). Department of Ayurveda, Yoga, & Naturopathy, Unani, Siddha and Homeopathy (AYUSH).Ministry of Health and Family Welfare, Government of India, New Delhi. 2015. p. - 34. Available From: www.Indianmedicine.nic.in. [Last accessed on 2020 Jun 06].  Back to cited text no. 13
    
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Sharma SR, editor. Sodhana Maran Prakran. In: Ayurved Sarasangraha. Allahabad: Shree Baidyanath Ayurved Bhavan Limited Publisher; 2015. p. 125.  Back to cited text no. 14
    
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Anonymous. The Ayurved Pharmcocopeia of India, part one, formulations. Government of India, ministry of health and family welfare, Department of Indian Systems of Medicine and Homeopathy, New Delhi. 2000. p. 154. Available From: https://dravyagunatvpm.wordpress.com/ayurvedic-formulary-of-india/. [Last accessed on 2020 Jun 06].  Back to cited text no. 15
    
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Wadha S, Singhal S, Rawat S. Bioavailability enhancement by Piperine: A review. Asian J Biomed Pharm Sci 2014;4:1-8.  Back to cited text no. 16
    
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Tripathi BN, editor. Commentary Dipika on Sharangdhar samhita, Madhyam Khand. Ch. 7. Ver. 95-100. Revised ed. Varanasi: Chaukhamba Surbharti Prakashan; 2004. p. 207-8.  Back to cited text no. 18
    
19.
The Ayurved Pharmcocopeia of India, part one, formulation. Government of India, ministry of health and family welfare, Department of Indian Systems of Medicine and Homeopathy, New Delhi. 2000: p - 59. Available From: https://dravyagunatvpm.wordpress.com/ayurvedic-formulary-of-india/. [Last accessed on 2020 Jun 06].  Back to cited text no. 19
    
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22.
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Case Report
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Follow-up and Ou...
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