Mesenteric Lymphadenitis and Terminal Ileitis is Associated With Yersinia Infection: A Meta-analysis

J Surg Res. 2022 Feb:270:12-21. doi: 10.1016/j.jss.2021.08.027. Epub 2021 Oct 7.


Background: Yersinia infection affects terminal ileum and lymph nodes and could therefore mimic the symptoms of appendicitis. We aimed to systematically characterise the suspected or confirmed abdominal diseases and/or surgeries associated with Yersinia infection.

Materials and methods: This systematic review and meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol (CRD42016053252) was uploaded to PROSPERO. The searches were conducted in PubMed and EMBASE on October 2, 2020. Original reports on patients with abdominal surgical diseases were included. The primary outcome was to characterise suspected or confirmed abdominal surgical diseases and/or surgeries associated with Yersinia infection, while the secondary outcomes were the positive rate of Yersinia species for each disease and surgery, and to investigate the rate of Yersinia spp. in different geographic regions. We calculated the weighted mean prevalence of positive tests for Yersinia spp. for the different diseases and surgeries according to the detection method and for subgroups based on geographic region.

Results: From the search, 33 studies were included in the systematic review and 18 in the meta-analysis. Across geographic regions, the weighted mean prevalence for Yersinia spp. was 51% (95% CI 34%-69%) in mesenteric lymphadenitis, 65% (95% CI 45%-85%) in terminal ileitis, and 8% (95% CI 2%-15%) in normal appendices.

Conclusions: Around half of the patients with mesenteric lymphadenitis and terminal ileitis were serologically positive for infections with Yersinia spp. Yersinia infection may cause unnecessary surgery for suspected appendicitis due to symptoms from mesenteric lymphadenitis or terminal ileitis.

Keywords: Appendectomy; Appendicitis; Ileitis; Mesenteric lymphadenitis; Yersinia enterocolitica; Yersinia pseudotuberculosis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Appendicitis* / complications
  • Appendicitis* / diagnosis
  • Appendicitis* / surgery
  • Appendix* / pathology
  • Crohn Disease* / complications
  • Humans
  • Mesenteric Lymphadenitis* / diagnosis
  • Mesenteric Lymphadenitis* / etiology
  • Mesenteric Lymphadenitis* / pathology
  • Yersinia Infections* / complications
  • Yersinia Infections* / diagnosis
  • Yersinia Infections* / epidemiology