Prevalence, Factors Associated, and Histological Pattern of Incidental Enlarged Mesenteric Lymph Nodes Among Patients Undergoing Laparotomy at Referral Hospitals in Central Tanzania: a Cross-sectional Study

Abstract

Background: There are different causes of incidental enlarged mesenteric lymph nodes found during laparotomy, which most of the time influence the postoperative course. These causes are variable across the globe, but the node pattern in our locality and the factors associated with the incidental enlarged mesenteric lymph nodes are not yet established. Due to the lack of an established protocol in our locality, there have been some mismanaged cases that led to several postoperative complications. Therefore this study aimed to evaluate the prevalence, factors associated with, and histological pattern of incidental mesenteric lymphadenopathy. Methodology: The 885 patients were conveniently recruited in the study. The incidental enlarged mesenteric lymph nodes were taken during surgery, processed and histologically analyzed as per pathological protocol. Obtained data were filled and analyzed by SPSS version 27. Binary logistic regression was used to examine clinical data, with a significance level of p < 0.05, to determine the factors linked to lymph node enlargement. Results: It was seen that 58.08% of the study group, were between the ages of 21 and 40. Male accounted for 71.53% of the total, while 252 individuals were female, making up 28.47%, with M: F ratio being 2.5:1. Pastoral tribes accounted for 5.87% of the total population. A total of 87.40% of patients were operated due to peritonitis. The prevalence of incidental lymphadenopathy was 12.5%. Identified risk factors in this study were HIV [(43.64%), and (p<.0001)], [smoking (71.43%), and (p<.0001)], [nomadic pastoralism (28.85%) (p<.0001)]. Of the incidental lymphadenopathy (N=111), 23.42% had granulomatous Tuberculous lesions, and 9.01% of lymph nodes harbored malignancy. About 47% of patients had histologically confirmed reactive lymph nodes while 20.72% had an inflammatory pattern. Conclusion and recommendation: The findings in this study indicated that pastoral tribes were prone to getting peritoneal Tuberculosis which predisposes them to getting incidental enlarged mesenteric lymph nodes, also, smoking, and immunocompromised patients were also factors associated with incidental enlarged mesenteric lymph nodes. Therefore, preoperative counseling and thorough investigations should be done in this patient group in case of incidental enlarged mesenteric lymph nodes during laparotomy to rule out life-threatening conditions and comorbidities that can be treated early to prevent longer hospital stays and dangerous outcomes for patients.