Expert Advice -- Swollen lymph nodes in bowel
My son (22 months old) has just been diagnosed as having swollen lymph nodes within his bowel. We went through a terrible time this past weekend with terrible abdominal pain and vomiting. They did x-rays and didn't see any problems. An ultrasound was done today and they found the swelling. The doctor says it is caused by a virus and therefore there isn't anything that can be done.
Question:Robert Steele
Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more
Abdominal pain in children is a funny thing because there are so many illnesses and conditions that can cause it. And some of these illnesses seemingly have nothing to do with the belly. Then there are things in the belly, such as swollen lymph nodes, that most people are unaware of but are relatively common causes of abdominal pain as well. The reasons for this phenomenon vary with the specific illness, but some understanding about the "weird" causes of abdominal pain may help lend some awareness as to what the doctors are looking for and the reasons for the tests that are done. So, before I address your concern of the lymph nodes causing belly pain, let me branch out a little to include other seemingly unusual causes.
One good way to think about abdominal pain in children is in a head-to-toe manner. In other words, start with the head and work your way down the body to help remember some the "non-belly" causes of the abdominal pain.
HEAD
Probably the most common "head" cause of abdominal pain is strep throat. It is quite a common scenario for children to have belly pain as the only symptom of strep throat. Strep throat can cause such symptoms as nausea and abdominal pain which makes it very difficult to distinguish between it and appendicitis. Why abdominal pain occurs with strep throat is not well understood. So, don't be surprised if the doctor swabs your child's throat in search of the cause of the stomach pain. Migraine headaches in older children may manifest themselves with the predominant symptom of belly pain. While controversial, there are some that believe that the same mechanisms that cause migraine headaches may also cause abdominal pain even to the point where there is no headache at all, only belly pain.
CHEST
The most common illness in the chest that can cause abdominal pain is pneumonia. The lower border of the lung sits on the diaphragm. When an infection of the lung (pneumonia) occurs along the portions of the lower lung, the infection can irritate the diaphragm thus giving the sensation of belly pain.
GENITALS
The testes of the male and the ovaries of the female are attached to nerves and blood vessels sort of like an eggs attached to a string. Most of the time, the connections of the testes and ovary keep them relatively stationary in the body. However, sometimes they may twist much like the egg would spin when suspended in air by the string. This twisting is called torsion and can cause pain that is felt in the abdomen.
LEGS
It is relatively uncommon for disorders of the legs to cause pain that is perceived by the child to be in the abdomen. However, infections or other problems within the hip joint may do this.
With all these areas of the body being likely culprits in the cause of abdominal pain, you can understand why the entire body is checked out even when the child says or acts like his pain is only in the stomach.
When we get viral infections, the virus circulates throughout the body and infects various tissues. Commonly, typical "cold" viruses infect the upper airway causing a runny nose, sore throat, etc. However, these same viruses may infect other parts of the body such as the bowels causing upset stomach with vomiting and diarrhea. On the other hand, these same viruses may infect tissues but not really cause a whole lot of specific symptoms other than fever. In either case, the body mounts an immune response to kill the virus. An important part of this immune response involves collecting all the dead virus particles and cells in the lymph nodes. This, in turn, causes the lymph nodes to enlarge. Sometimes these lymph nodes enlarge so much or enlarge so fast that it causes pain.
This is most commonly noticed in the neck where there are many lymph nodes. When we get a cold, these neck lymph nodes enlarge and mild pain is experienced. Enlarged lymph nodes are not a bad thing, in fact, they are a good thing. It means the body is trying to fight the infection. However, there are lymph nodes through the body including inside the abdomen. What your son's doctor was saying was one of two things: 1) the viral illness caused his lymph nodes to enlarge which caused the abdominal pain or 2) he had a viral infection that infected the tissues of the bowel causing the abdominal pain, and the enlarged lymph nodes are just a normal finding on ultrasound in someone who has a viral illness. Either scenario can cause abdominal pain, and in fact, both of these things could be acting together to cause the pain. Unfortunately, just like the common cold, there are no medications to fight most of these viruses, therefore, all one can do is let it run its course and take anti-pain medications such as acetaminophen (Tylenol). I am sorry to hear of your little boy's bout with this pain, and I hope things have resolved well for him. The enlarged lymph nodes tend to go away once the viral illness is licked and generally causes no lasting difficulties although they may be more likely to enlarge again with the next viral illness.
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