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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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in Central Tanzania: a Cross-sectional Study DEVOTHA RWEYEMAMU, MASUMBUKO Y. MWASHAMBWA This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4943758/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Feb, 2025 Read the published version in BMC Surgery → Version 1 posted 10 You are reading this latest preprint version 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. Incidental mesenteric lymph node enlargement Background Within the mesentery, a tissue fold that connects the intestines to the posterior abdominal wall, are mesenteric lymph nodes, essential parts of the lymphatic system (Moos et al., 2024 ). These nodes are essential for immune surveillance because they filter lymph fluid, and trap pathogens, foreign objects, and cancer cells (Moos et al., 2024 ). Incidental findings refer to unexpected discoveries made during medical examinations or procedures conducted for unrelated reasons (Tan et al., 2017). Thus, mesenteric lymph nodes that are incidentally discovered to be enlarged during a laparotomy a surgical operation typically used for other diagnostic or therapeutic purposes are known as incidental enlarged mesenteric lymph nodes (IMLNs) (Chen, L., Yang, Y., Chen, 2018). Incidental enlarged mesenteric lymph nodes may have a heavy burden on account of the possible effects on patient outcomes and care (Tang & Alabousi, 2024). Finding enlarged lymph nodes may require further diagnostic testing, such as a histological analysis, to identify the underlying cause (Corwin et al., 2012). Extra procedures and possible requirements in the original condition's final treatment can result from incidentally found enlarged mesenteric lymph nodes (Iqbal et al., 2015). Surgeons usually detect incidental enlarged mesenteric lymph nodes during laparotomy by palpating and visually inspecting the patient (Zafar et al., 2018). During a standard abdominal cavity examination, these nodes might be observed as well (Unlu et al., 2016 ). The size and appearance of the nodes are the main determining factors for enlargement; nodes with a diameter of more than 1 cm are regarded as enlarged (Sando et al., 2017 ). Preoperative imaging tests like computed tomography (CT), magnetic resonance imaging (MRI), or intraoperative ultrasonography may occasionally result in incidental discovery (Ezhapilli, S. R., Moreno, C. C., Small, W. C., Hanley, K., Kitajima, H. D., Mittal, 2014; Lu et al., 2020). It is important to identify incidental enlarged mesenteric lymph nodes for several reasons. First of all, these nodes' existence can offer crucial diagnostic hints regarding underlying diseases that might not have been recognized in the past (Kavanagh, P. V., Grosskreutz, S. R., Flancbaum, 2019). They might, for instance, point to an underlying infection, inflammatory condition, or cancer, necessitating more investigations and suitable treatment (Maconi, 2014 ). Second, histological analysis of these nodes can aid in the distinction between benign and malignant lymph node enlargement sources, hence directing further treatment decisions (Corwin et al., 2012). For example, cancer would demand a different therapeutic approach, whereas benign reactive hyperplasia might not require any additional care (Helbling et al., 2017 ). To address this challenge, the goal of this study was to provide knowledge on the prevalence, risk factors as well and patterns of incidental mesenteric lymphadenopathy considered to be unusual and requiring additional assessment in addition to providing expert opinion on the management of this condition. Bridging this knowledge gap will also assist in identifying modifiable risk factors for this disorder, which may give clinicians important information on how to lower the risk factors and find the most appropriate treatment. Materials and Methods This was a hospital-based cross-sectional study and was conducted to assess the Prevalence, Risk Factors, and Histological Pattern of Incidental Enlarged Mesenteric Lymph Nodes in patients requiring emergency laparotomy in central Tanzania, from July 2023 to June 2024. This study was conducted in Dodoma (Benjamin Mkapa Hospital & Dodoma regional referral hospital), and Iringa regional referral hospital. These hospitals serve as referral hospitals in Iringa and Dodoma regions. This study included all candidates who underwent emergency exploratory laparotomy in the respective hospitals. All patients who underwent laparotomy at the respective hospitals, stable patients who could tolerate the procedure, and patients who consented to laparotomy were included in the study. Patients with confirmed Peritoneal Tuberculosis, patients with known abdominal malignancies, and patients with advanced or neglected peritonitis were excluded from the study. In this study, mesenteric lymphadenopathy and histopathological patterns were considered as dependent variables. Exposure variables were Demographic factors and clinical factors. The sample size was calculated using this formula of a single proportion, where; n = was the minimum sample size required Z = standard normal deviation set at 1.96 (corresponding to a confidence level of 95%), ε = marginal error to be used of 5.0%, P = prevalence of patients with incidental enlarged mesenteric lymphadenopathy was found to be 38.8% (Islam et al., 2014). Therefore, the proposed sample size was 365 patients. During the study period, 894 patients had exploratory laparotomies in the hospitals where the study was being carried out. 9 patients were excluded from the study (had confirmed malignancies) 885 were recruited. A convenient sampling technique was used. Subjects were selected among and available consented and who had met the inclusion criteria for the study then were enrolled. Data Collection Patients' characteristics such as age (years), sex, comorbidities, smoking tendency, preoperative diagnosis, history of medications, fever, weight loss, and history of previous surgeries were obtained directly from the patient. No effort was made to diagnose mesenteric lymphadenopathy preoperative, as these patients were sick requiring emergency surgery. All patients were resuscitated according to the hospitals’ protocols until they were hemodynamically stable. They were prepared for surgery, a written informed consent for both an emergency laparotomy and lymph node sampling was obtained. All patients were approached in the same manner, in which, a standard extended midline incision was made; the primary pathology was dealt with according to protocol. After abdominal lavage, the mesentery was thoroughly palpated to identify any enlarged lymph nodes. When found dissection and removal of all nodes more than 1 centimeter in diameter were done, (Sando et al., 2017) using surgical instruments, and the obtained lymph node samples were stored in a sample collection bottle filled with 10% formaldehyde solution for fixing, then transported to the laboratory for histopathological workups. Post-operative, patients were followed for one week to observe for any complications following lymph node dissection such as bleeding, infection, and iatrogenic intestinal perforation. If there were any complications, the patient was managed accordingly. Histological examination Following tissue fixation, the specimen may have required further dissection in the laboratory to obtain an appropriate area for examination. The obtained specimen after dissection underwent the next step called dehydration, where it was immersed in a series of alcohol solutions to remove water from the specimen since the next step in its preparation required no water at all because the paraffin wax used was hydrophobic. The next step in the laboratory was clearing, where a clearing reagent was used to impart optical clarity or transparency to the tissue due to its relatively high refractive index. The next step was wax infiltration, where a suitable histological wax was used, the last step was tissue embedding or blocking out, in this step, the specimen was formed into a block, which was then clamped into a microtome for section cutting after it was examined for histopathology under a high power field microscope with magnification up to times 400. A tissue biopsy with positive histopathological results suggestive of malignancy was referred to oncologists after surgical resection for further management. For those that were suggestive of any other pathology, patients were subjected to a respective treatment or channeled to a respective department, respectively. The workups were requested by filling out an investigation form and the results were interpreted and attached to a respective document of a patient. Data processing and analysis The data collected was directly filled into a spreadsheet and checked for correctness and consistency to avoid errors. Descriptive characteristics of the study population, prevalence, and risk factors for MSL were examined using frequency and tables, while numerical variables were summarized as means with standard deviation. The chi-square test of association was used to test the association of the risk factors. Multivariable statistical analysis was used to identify factors associated with incidental mesenteric lymphadenopathy, including the use of regression models to analyze the connection between risk factors and the result of interest. Data was collected and analyzed using Statistical Package for the Social Sciences version 27. RESULTS During the study period, 894 patients had exploratory laparotomies at the referral hospitals in central Tanzania. 9 patients were excluded from the study (met exclusion criteria) and 885 were recruited. It was discovered that of the 885, 111 of these patients had incidental enlarged mesenteric lymph nodes. It was also seen that, 58.08% of the study group, or most patients, were between the ages of 21 and 40, of the total participants, 633 persons were male, accounting 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. Peasants were found to have mesenteric lymphadenopathy (58.42%) compared to individuals in other occupations, whereby individuals who were self-employed or engaged in business (24.18%), and a very small percentage are employed (1.92%) or unemployed (15.48%). The prevalence of mesenteric lymphadenopathy was 12.5%. HIV was present in a significant portion of individuals (21.60%). It was observed that 3.60% of these patients had hypertension and diabetes mellitus. Smoking was relatively common, with 22.50% of patients having a history of smoking. The vast majority of patients (96.40%) had not had previous abdominal surgery. In this patient population, peritonitis was the most common cause of surgery (87.40% of cases). With 12.60% of cases, intestinal obstruction (IO) was a less frequent surgical indication. 45.90% of the patients had a fever history. Also, 24.30% had weight loss, and 41.40 percent of the patients were taking medications. Other characteristics are summarized in Table 1 and Table 2 Table 1 Demographic characteristics of the patients undergoing laparotomy found with lymphadenopathy Variable Frequency Percent Sex Female 252 28.47 Male 633 71.53 Age categories in years ≤20 47 5.31 21–40 514 58.08 41–60 260 29.38 61–80 59 6.67 81+ 5 0.56 Tribes Non-pastoral tribes 833 94.13 Pastoral tribes 52 5.87 Occupation Peasant 517 58.42 Employed 17 1.92 Self-employed/business 214 24.18 Unemployed 137 15.48 Table 2 Comorbidities and surgical characteristics of the patients undergoing laparotomy found with lymphadenopathy Variable Frequency Percent HIV No 87 78.40 Yes 24 21.60 Diabetes mellitus No 107 96.40 Yes 4 3.60 Hypertension No 107 96.40 Yes 4 3.60 Smoking No 86 77.50 Yes 25 22.50 Previous abdominal surgery No 107 96.40 Yes 4 3.60 Surgical indication IO 14 12.60 Peritonitis 97 87.40 Fever No 60 54.10 Yes 51 45.90 Medication No 65 58.60 Yes 46 41.40 Weight loss No 84 75.70 Yes 27 24.30 Under sex, there doesn't appear to be a significant association (p = 0.9295) between gender and enlarged lymph nodes. In contrast, for variables like Tribes, Occupation, HIV status, Diabetes, Hypertension, history of medication, weight loss, fever, and others, there are significant associations (p < 0.05), suggesting these factors may influence the likelihood of incidental enlarged mesenteric lymph nodes. Regarding tribes, it was observed that among patients with incidentally enlarged mesenteric lymph nodes, patients from non-pastoral tribes have a lower likelihood of having incidental enlarged mesenteric lymph nodes (11.52%) compared to patients from pastoral tribes (28.85%). Regarding occupation of the patients, it was observed that among patients with incidentally enlarged mesenteric lymph nodes, a large proportion were peasants (17.79%) followed by employed (17.65%). Concerning comorbidities, it was observed that among patients with incidentally enlarged mesenteric lymph nodes, a large proportion had comorbidities HIV (43.64%), Diabetes mellitus (44.44%), and Hypertension (44.44%). The findings also showed that among patients with incidental mesenteric lymphadenopathy, a large proportion had a history of fever, using medication, weight loss, and no previous abdominal surgery. Lastly, the results show that among patients with incidental enlarged mesenteric lymph nodes, a large proportion had Peritonitis (18.00%). (see Table 3 ). Table 3 Factors associated with incidental enlarged mesenteric lymph nodes among patients undergoing laparotomy Variable No mesenteric lymph N (%) Mesenteric lymph N (%) Chis-Value p-value Sex 0.0078 0.9295 Female 220(87.30) 32(12.70) Male 554(87.52) 79(12.48) Age categories in years 4.2250 0.3764 ≤20 38(80.85) 9(19.15) 21–40 457(88.91) 57(11.09) 41–60 226(86.92) 34(13.08) 61–80 49(83.05) 10(16.95) 81+ 4(80.00) 1(20.00) Tribes < .0001* Pastoral tribes 37(71.15) 15(28.85) Non-pastoral tribes 737(88.48) 96(11.52) Occupation 35.7712 < .0001 Peasant 425(82.21) 92(17.79) Employed 14(82.35) 3(17.65) Self-employed/business 200(93.43) 14(6.54) Unemployed 135(98.54) 2(1.46) HIV 51.6896 < .0001 No 743(89.52) 87(10.48) Yes 31(56.36) 24(43.64) Diabetes mellitus 0.0179* No 769(87.79) 107(12.21) Yes 5(55.56) 4(44.44) Hypertension 0.0179* No 769(87.79) 107(12.21) Yes 5(55.56) 4(44.44) Smoking < .0001 No 764(89.88) 86(10.12) Yes 10(28.57) 25(71.43) Previous abdominal surgery 0.0002* No 774(87.85) 107(12.15) Yes 0(0.00) 4(100.00) Surgical indication 37.3848 < .0001 IO 332(95.95) 14(4.05) Peritonitis 442(82.00) 97(18.00) Medication < .0001 No 774(92.80) 60(7.20) Yes 0(0.00) 51(100.00) Fever < .0001 No 774(92.25) 65(7.75) Yes 0(0.00) 46(100.00) Weight loss < .0001 No 774(90.20) 84(9.80) Yes 0(0.00) 27(100.00) Binary logistic regression was used to assess the factors associated with incidental enlarged mesenteric lymph nodes. The results show that after controlling for other variables, incidental mesenteric lymphadenopathy was statically significantly associated Non-pastoral tribes (p < 0.0001), Peasants (p < 0.0003), HIV (p < .0001), Diabetes Mellitus (p = 0.0356), smoking (p < .0001) and surgical indication (p < .0001). Compared to people from non-pastoral tribes, members of pastoral tribes have a higher percentage of incidentally enlarged mesenteric lymph nodes (AOR = 3.112, p < .0001). Regarding the occupation of the patients, it was observed that Peasants are more likely to present with incidentally enlarged mesenteric lymphadenopathy (AOR = 16.460, p = 0.0003) compared to other patients. The findings also show that HIV-positive patients are more likely to have incidental mesenteric lymphadenopathy (AOR = 7.057, p < .0001) compared to those with no HIV. In addition to that, diabetic patients were more likely to have incidental enlarged mesenteric lymph nodes (AOR = 6.564, p = 0.0356) compared to non-diabetic patients. Smoking patients are more likely to have incidental mesenteric lymphadenopathy (AOR = 10.324, p < .0001) compared to non-smokers. The findings show that Peritonitis patients were more likely to have incidental enlarged mesenteric lymph nodes (AOR = 3.930, p < .0001) compared to Intestinal obstruction patients. See Table 4 . Table 4 Binary logistic regression for the factors associated with incidental enlarged mesenteric lymph nodes among patients undergoing laparotomy. Variable UNADJUSTED ADJUSTED OR [95% CI] p-Value AOR [95% CI] p-Value Tribes Non-pastoral tribes Ref Ref Pastoral tribes 3.112[1.647,5.882] < .0001 3.112[1.647,5.882] < .0001 Occupation Peasant 14.612[3.552,60.100] 0.0002 16.460[3.675,73.720] 0.0003 Employed 14.464[2.225,94.026] 0.0052 2.921[0.301,28.357] 0.3552 Self-employed/business 4.725[1.057,21.125] 0.0421 3.985[0.808,19.665] 0.0896 Unemployed Ref Ref HIV No Ref Ref Yes 6.612[3.712,11.777] < .0001 7.057[2.975,16.741] < .0001 Diabetes mellitus No Ref Ref Yes 5.750[1.520,21.745] 0.0100 6.564[1.135,37.945] 0.0356 Hypertension No Ref Ref Yes 5.750[1.520,21.745] 0.0100 0.541[0.053,5.540] 0.6044 Smoking No Ref Ref Yes 22.198[10.315,47.772] < .0001 10.324[3.745,28.458] < .0001 Surgical indication IO Ref Ref Peritonitis 5.204[2.919,9.278] < .0001 3.930[2.040,7.572] < .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. DISCUSSION Prevalence of incidental enlarged mesenteric lymph nodes The prevalence of incidental mesenteric lymphadenopathy of 12.5% in this study differs from the study by Vayner et al., ( 2003 ) which showed the prevalence of mesenteric lymphadenopathy to be 61.4%, Gawad et al., (2016), found a slightly higher prevalence of 68% while Unlu et al., ( 2016 ) reported a lower prevalence of 7%. In all studies, patients were characteristically different from the index study explaining the differences, while in the study by Vayner, the methodology included only children, possibly increasing the prevalence. Comparatively speaking, our study and the others' findings are comparable in that mesenteric lymphadenopathy was more common in the male gender in both studies (Vayner et al., 2003 ). The prevalence in this study also differs from another study done in children, whereby a higher prevalence of 61.4% of enlarged mesenteric lymph nodes was observed in children involved in the study (Gross et al., 2017). The higher prevalence difference could be because mesenteric lymphadenopathy is a more common finding in children than the adult population which was most common in our study population (Sahar Javed et al., 2022 ). Another higher prevalence of mesenteric lymph node enlargement was in 72.1% of the cases and 13.4% of controls in Sri Lanka in children who presented with chronic abdominal pain (Balakrishnan et al., 2018). This differs from our study probably due to the differences in the study population. Unlike our adult study population, it is similar to our study that lymphadenopathy was prevalent in the male gender same as in our study. Factors associated with incidental enlarged mesenteric lymph nodes: The nomadic pastoral tribes were the most afflicted group in the study population, a statistically significant (p < .0001) difference, which may have been caused by several elements inherent in their way of life and cultural customs. Katale et al., ( 2013 ) indicated that Maasai people who are nomadic pastoralists are at considerable risk due to their custom of consuming raw milk, which puts them at risk for diseases like tuberculosis (TB). Bovine mycobacterium bovis is a species of bacteria that can cause tuberculosis (TB) in humans when consumed through unpasteurized dairy products (Bolaños et al., 2017 ). Nomadic pastoralism is a factor associated with several diseases, in a study regarding epidemic-prone diseases among pastoralists in Uganda, it was revealed that nomadic pastoralism is a factor associated with the occurrence and reoccurrence of epidemic diseases (Cummings et al., 2014). These similarities with the index study are probably due to the similar manner of living among pastoral tribes. Compared to other occupational groups, peasants, or those involved in manual labor and small-scale farming, were shown to have a higher incidence of incidentally enlarged mesenteric lymph nodes. Dwivedi et al., ( 2023 ) indicated that lower socioeconomic position is frequently associated with inferior living circumstances, inadequate nutrition, and restricted access to healthcare which put one at greater risk for infections and other illnesses that might lead to lymphadenopathy, consistent with the findings of this study. The danger may be further increased by the physically demanding nature of peasants and possible exposure to environmental infections as shown by Donnelly et al., ( 2018 ) that there is an association between low socioeconomic status and increased risks of infection and hospitalization in people of low socioeconomic status such as peasants in the index study. These studies are in line with the index study possibly because peasants in this study are from poor socioeconomic societies. Incidental enlarged mesenteric lymph nodes were more common in patients whose surgical indication was peritonitis. This finding is similar to a study by Felten et al., ( 2019 ), that indicated peritoneal contamination by intestinal contents can result in mesenteric lymphadenopathy. The relationship between peritonitis and lymph node enlargement is highlighted by the inflammatory process as well as the presence of bacteria or other irritants in the abdominal cavity which is the site of a possible intermediate phase in the immune response (Malbon et al., 2019 ). This is in line with the index study possibly because most patients being attended at these referral facilities have neglected peritonitis warranting prolonged exposure to irritants in the abdominal cavity leading to mesenteric lymphadenopathy. In the index study, incidental enlarged mesenteric lymph nodes were more common in patients with comorbidities, such as HIV and diabetes than in patients without these illnesses. A similar observation was seen in one study that indicated HIV was a risk factor for developing mesenteric lymphadenopathy (Javed et al., 2022 ). It is known that HIV is an immune system-attacking virus, increasing susceptibility to infections, including those that might result in lymphadenopathy as reported by Deeks et al., ( 2015 ) and Taramasso et al., ( 2016 ). Similar to this, diabetes weakens the immune system and makes people affected more prone to infections (Berbudi et al., 2020 ; Jwad & Al-Fatlawi, 2022 ). Enlarged lymph nodes are more common in the immunocompromised, which can be explained by the chronic nature of these diseases and their effect on the body's defenses against infections (Lucas, 2017). These studies support the findings of the index study perhaps as a consequence of the immunosuppressive nature of these comorbidities. This study revealed smoking is a significant risk factor, with smokers having an increased likelihood of incidentally enlarged mesenteric lymph nodes compared to non-smokers. Similarly, in one study on mesenteric lymphadenitis as a presenting feature of Whipple's disease, smoking was also found to be one of the risk factors (Chizinga et al., 2017 ). The difference with the index study is that only patients with Whipple's disease were recruited. Yamaguchi et al., (2019) indicated that the immune system is known to be negatively impacted by smoking, and one of these impacts is that it hinders the body's capacity to mount efficient defenses. Similarly, Jiang et al., ( 2020 ) indicated that smokers may be more vulnerable to infections and inflammatory diseases that cause lymph node enlargement as a result of this immunosuppressive effect. Furthermore, smoking has been linked to long-term respiratory disorders, which may have an indirect impact on the lymphatic system and how it functions (Margaritopoulos et al., 2015 ). The above studies are in line with the index study’s findings perhaps because smokers are prone to immunosuppression which makes them susceptible to abdominal infections and consequently mesenteric lymphadenopathy. Histological pattern of incidental enlarged mesenteric lymph nodes Pathological investigation of the 111 patients with incidentally enlarged mesenteric lymph nodes showed a varied pattern of underlying diseases. Interestingly, Tuberculous granulomatous lesions were present in 26 patients (23.42%), a strong diagnostic of peritoneal tuberculosis (TB). In line with the index study, a prevalence of 31–58% of abdominal TB was reported by Rossi et al., ( 2020 ). The similarity to the index study is that the cohort involved was from a developing country. The index study is also in line with a study that was done in India that indicated Tuberculous lymphadenopathy being the commonest form of abdominal TB showing the importance of thorough investigations when mesenteric lymphadenopathy is noted (Govil et al., 2022 ). Fillion et al., ( 2016 ) reported a higher prevalence of 67% of peritoneal TB in their study that aimed to describe the characteristics and treatment of patients presenting with abdominal tuberculosis. This differs from our study probably because a smaller number of patients (21) were included in their study. On the other hand, it was discovered that 10 individuals (9.01%) had cancer linked to their enlarged mesenteric lymph nodes. Lucey B.C et al., (2005) indicated that colorectal cancer and pancreatic carcinoma are frequently associated with local mesenteric lymphadenopathy in line with this study giving a clue that enlarged mesenteric lymph nodes should be investigated. Given that malignancies might have substantial prognostic and therapeutic implications, this subgroup is an important component of incidental findings during laparotomies (Kang et al., 2011 ). Primary tumors arising in the mesenteric lymph nodes as well as secondary metastatic lesions are among the types of malignancies found incidentally during laparotomy (Dufay et al., 2012 ). The identification of mesenteric lymphadenopathy incidentally emphasizes the necessity of close observation and a comprehensive histological assessment of the mesenteric lymph nodes to guarantee an early and precise cancer diagnosis (Moos et al., 2024 ). Same as in the index study, both primary and secondary mesenteric tumors were observed necessitating the importance of histological examination. Reactive mesenteric lymph nodes were present in 52 patients (46.84%) of the total number of patients. Usually, reactive lymphadenopathy is an indication of a benign condition that is occurring elsewhere in the body, such as an infection or inflammation that does not need surgery (Helbling et al., 2017 ). However, it is important to further investigate the reactive lymph histological pattern (Tzankov & Dirnhofer, 2018 ). To distinguish between more dangerous illnesses that may first present similarly and benign reactive alterations, it is imperative to identify and closely monitor these patients with reactive lymphadenopathy (Tzankov & Dirnhofer, 2018 ). Additionally, the mesenteric lymph nodes of 23 individuals (20.72%) showed signs of chronic nonspecific inflammation which are non-specific hyperplasia and edema. Patients with long-term inflammatory diseases including Crohn's disease, ulcerative colitis, and other types of inflammatory bowel disease (IBD) usually present with this lymph node pattern (Unlu et al., 2016 ). Significant lymph node enlargement caused by mesentery inflammation may be symptomatic or incidentally detected (Helbling et al., 2017 ). Treating the underlying inflammatory illness in these patients entails using biological medicines, immunosuppressants, and corticosteroids (Maconi, 2014 ). Monitoring closely and following up often are necessary to control illness flare-ups and avoid consequences (Dwivedi et al., 2023 ). These results demonstrate the diversity and intricacy of incidental mesenteric lymphadenopathy. Granulomatous, malignant, reactive, and inflammatory patterns all call for different approaches to diagnosis and treatment (Koo, H., Jang, H., Kim, 2021 ). It is impossible to exaggerate the significance of carefully examining incidental findings made during laparotomies since doing so makes it possible to identify potentially dangerous underlying diseases that could otherwise go undetected in line with another study (Tzankov & Dirnhofer, 2018 ). To guarantee thorough assessment and the best possible patient care, cooperation between surgeons, pathologists, infectious disease specialists, oncologists, and gastroenterologists is essential. Better patient outcomes, proper therapy, and accurate diagnosis are made possible by this integrated approach (Bayramoğlu et al., 2019 ). Conclusion Enlarged mesenteric lymph nodes found incidentally during laparotomy indicate an ongoing infection or pathology that needs attention. Therefore, thorough investigations should be done 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 complications, longer hospital stays, and dangerous outcomes for patients. Abbreviations BMH Benjamin Mkapa Hospital DRRH Dodoma Regional Referral Hospital HIV Human Immunodeficiency Virus IO Intestinal obstruction IRRH Iringa Regional Referral Hospital LN Lymph node Declarations Ethical approval and consent to participate: Ethical approval was obtained from The Dodoma University Research Review Ethics Committee. All participants who accepted to be recruited in the study signed a written consent form. Consent for publication: not applicable Human Ethics and Consent to Participate declarations: not applicable Internal Review Board: The Dodoma University Research Review Ethics Committee. Availability of data and material https://drive.google.com/file/d/1RRLywumudIY3iNzDf1nvfRYZWPrersew/view?usp=sharing Competing interest: The authors declare that they have no competing interests. Funding sources : Personal funds. Author contributions: DR- conception and design of the study, acquisition, and analysis of data, drafting the manuscript, and submission of the manuscript. MYM- conception and design of the study, acquisition, and analysis of data, finalizing of the manuscript and correspondence. All authors hereby declare that they read and approved the final manuscript before submission for publication. Acknowledgment: We would like to acknowledge the contributions of Mr. and Mrs. Josephat Rweyemamu and Dr. Francis Zerd for their endless support throughout this research. References Abdel Gawad, E. A., Abu Samra, M. F., & Talat, A. M. (2016). The utility of multi-detector CT in detection and characterization of mesenteric lymphadenopathy with histopathological confirmation. Egyptian Journal of Radiology and Nuclear Medicine , 47 (3), 757–764. https://doi.org/10.1016/j.ejrnm.2016.06.020 Bayramoğlu, Z., Yılmaz, R., Demir, A. A., Ataizi-Çelikel, Ç., Kombak, F. E., İkinci, A., & Yekeler, E. (2019). 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Acute Nonspecific Mesenteric Lymphadenitis: More Than “no Need for Surgery.” In BioMed Research International (Vol. 2017). Hindawi Publishing Corporation. https://doi.org/10.1155/2017/9784565 Javed, S., Nadeem, K., & Zahid, M. (2022). Prospects of mesenteric lymphadenopathy in children with chronic abdominal pain (CAP). The Professional Medical Journal , 29 (06), 818–822. https://doi.org/10.29309/tpmj/2022.29.06.6958 Jiang, C., Chen, Q., & Xie, M. (2020). Smoking increases the risk of infectious diseases: A narrative review. Tobacco Induced Diseases , 18 . Jwad, S. M., & Al-Fatlawi, H. Y. (2022). Types of diabetes and their effect on the immune system. J Adv Pharm Pract , 4 (1), 21–30. Kang, J., Hur, H., Min, B. S., Kim, N. K., & Lee, K. Y. (2011). Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer. Annals of Surgical Oncology , 18 , 704–710. Katale, B. Z., Mbugi, E. V, Karimuribo, E. D., Keyyu, J. D., Kendall, S., Kibiki, G. S., Godfrey-Faussett, P., Michel, A. L., Kazwala, R. R., & Van Helden, P. (2013). Prevalence and risk factors for infection of bovine tuberculosis in indigenous cattle in the Serengeti ecosystem, Tanzania. BMC Veterinary Research , 9 , 1–11. Kawooya, M. G. (2013). Abdominal ultrasound findings in HIV and tuberculosis. Imaging in Medicine , 5 (3), 265. Koo, H., Jang, H., Kim, M. (2021). Mesenteric lymphadenopathy: Etiology and diagnostic approach. Radiology Clinics of North America , 59 (3), 453–470. Lucey, B. C., Stuhlfaut, J. W., & Soto, J. A. (2005). Mesenteric lymph nodes seen at imaging: Causes and significance. Radiographics , 25 (2), 351–365. https://doi.org/10.1148/rg.252045108 Maconi, G. (2014). Mesenteric Lymphadenopathy. In G. Maconi & G. Bianchi Porro (Eds.), Ultrasound of the Gastrointestinal Tract (pp. 29–36). Springer Berlin Heidelberg. https://doi.org/10.1007/174_2012_719 Malbon, A. J., Meli, M. L., Barker, E. N., Davidson, A. D., Tasker, S., & Kipar, A. (2019). Inflammatory mediators in the mesenteric lymph nodes, site of a possible intermediate phase in the immune response to feline coronavirus and the pathogenesis of feline infectious peritonitis? Journal of Comparative Pathology , 166 , 69–86. Margaritopoulos, G. A., Vasarmidi, E., Jacob, J., Wells, A. U., & Antoniou, K. M. (2015). Smoking and interstitial lung diseases. European Respiratory Review , 24 (137), 428–435. Mendiratta, P., Rai, A. K., & Sharma, R. (2023). Prevalence and Significance of Mesenteric Lymphadenopathy in Children with Functional Abdominal Pain Disorder-Not Otherwise Specified: A Novel Ultrasonography based Retrospective Case Control Study. Tropical Gastroenterology , 43 (4), 204–209. Mohammed, H., Assefa, N., & Mengistie, B. (2018). Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis. HIV/AIDS-Research and Palliative Care , 225–237. Moos, V., von Lampe, B., & Schneider, T. (2024). Massive Mesenteric Lymphadenopathy: An Unusual Outcome. Gastroenterology , 166 (5), e5–e9. https://doi.org/https://doi.org/10.1053/j.gastro.2023.11.040 Papoutsopoulou, S., Satsangi, J., Campbell, B. J., & Probert, C. S. (2020). impact of cigarette smoking on intestinal inflammation—direct and indirect mechanisms. Alimentary Pharmacology & Therapeutics , 51 (12), 1268–1285. Raju Sharma, M. K. S., & Kandasamy, D. (2019). Imaging in Abdominal Tuberculosis. Imaging in Tuberculosis: Clinicopathological Correlation , 121. Rehal, S., Stephens, M., Roizes, S., Liao, S., & von der Weid, P.-Y. (2018). Acute small intestinal inflammation results in persistent lymphatic alterations. American Journal of Physiology-Gastrointestinal and Liver Physiology , 314 (3), G408–G417. Rossi, A., Melone, V., Turco, R., Camera, L., Bruzzese, E., Miele, E., Staiano, A., Guarino, A., & Lo Vecchio, A. (2020). Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report. Italian Journal of Pediatrics , 46 , 1–7. Sando, M., Terasaki, M., Okamoto, Y., Suzumura, K., & Tsuchiya, T. (2017). The utility of diagnostic laparoscopic biopsy for mesenteric and retroperitoneal lymph nodes. The American Journal of Case Reports , 18 , 878. Singh, I. K. (2020). Mesenteric lymphadenopathy: A common cause of chronic abdominal pain in children. International Journal , 3 (1), 28. Taramasso, L., Tatarelli, P., & Di Biagio, A. (2016). Bloodstream infections in HIV-infected patients. Virulence , 7 (3), 320–328. Tzankov, A., & Dirnhofer, S. (2018). A pattern-based approach to reactive lymphadenopathies. Seminars in Diagnostic Pathology , 35 (1), 4–19. Unlu, E., Okur, N., Acay, M. B., Kacar, E., Ozdinc, S., Balcik, C., & Tokgoz, O. T. (2016). The Prevalence of Incidentally Detected Idiopathic Misty Mesentery on Multidetector Computed Tomography: Can Obesity Be the Triggering Cause? Canadian Association of Radiologists Journal , 67 (3), 212–217. https://doi.org/10.1016/j.carj.2015.06.004 Vayner, N., Coret, A., Polliack, G., Weiss, B., & Hertz, M. (2003). Mesenteric lymphadenopathy in children examined by US for chronic and/or recurrent abdominal pain. Pediatric Radiology , 33 (12), 864–867. https://doi.org/10.1007/s00247-003-0985-7 Yamaguchi, N. H. (2019). Smoking, immunity, and DNA damage. Translational Lung Cancer Research , 8 (Suppl 1), S3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Feb, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 30 Sep, 2024 Reviews received at journal 26 Sep, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviews received at journal 12 Sep, 2024 Reviewers agreed at journal 05 Sep, 2024 Reviewers invited by journal 05 Sep, 2024 Editor invited by journal 03 Sep, 2024 Editor assigned by journal 03 Sep, 2024 Submission checks completed at journal 03 Sep, 2024 First submitted to journal 20 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4943758","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":360686523,"identity":"cb48d46d-e3b3-4f3e-a364-9e11fa326c5f","order_by":0,"name":"DEVOTHA RWEYEMAMU","email":"","orcid":"","institution":"University of Dodoma","correspondingAuthor":false,"prefix":"","firstName":"DEVOTHA","middleName":"","lastName":"RWEYEMAMU","suffix":""},{"id":360686524,"identity":"0be8d1e9-3531-4fbb-a4b2-78da02463696","order_by":1,"name":"MASUMBUKO Y. MWASHAMBWA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBADOTZmxsYHQAYPH3EaEhiM+dmZmw1AWtiI1ZI4s5+9TQLEJqhFt/34M2neH9sYNxxmbKv8mmMnw8bA/PDRDTxazM7kmEnzJNxmNgBquS27LRnoMDZj4xx8Wg7ksIG0sIG1SG5jBmrhYZPGq+X882cgLTwgLcWS2+qJ0HIjAewwCclmxjbGj9sOE6PljbHlnLTbBvzMjM3SjNuO87AxE/LL+fSHN97Y3K5v4z/+8OPPbdX2/OzNDx/j0wICTDxQBjOYwUxAOQgw/kBnjIJRMApGwShABgBWMUX4OL6rHQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Dodoma","correspondingAuthor":true,"prefix":"","firstName":"MASUMBUKO","middleName":"Y.","lastName":"MWASHAMBWA","suffix":""}],"badges":[],"createdAt":"2024-08-20 09:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4943758/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4943758/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-024-02745-0","type":"published","date":"2025-02-11T15:57:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":76487649,"identity":"2f03d666-16bc-4b2a-8924-804d1ae5f606","added_by":"auto","created_at":"2025-02-17 16:10:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1111450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4943758/v1/09b67bf0-3f4d-44a1-b3f2-f7548787cb91.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence, 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\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eWithin the mesentery, a tissue fold that connects the intestines to the posterior abdominal wall, are mesenteric lymph nodes, essential parts of the lymphatic system (Moos et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These nodes are essential for immune surveillance because they filter lymph fluid, and trap pathogens, foreign objects, and cancer cells (Moos et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Incidental findings refer to unexpected discoveries made during medical examinations or procedures conducted for unrelated reasons (Tan et al., 2017). Thus, mesenteric lymph nodes that are incidentally discovered to be enlarged during a laparotomy a surgical operation typically used for other diagnostic or therapeutic purposes are known as incidental enlarged mesenteric lymph nodes (IMLNs) (Chen, L., Yang, Y., Chen, 2018).\u003c/p\u003e \u003cp\u003eIncidental enlarged mesenteric lymph nodes may have a heavy burden on account of the possible effects on patient outcomes and care (Tang \u0026amp; Alabousi, 2024). Finding enlarged lymph nodes may require further diagnostic testing, such as a histological analysis, to identify the underlying cause (Corwin et al., 2012). Extra procedures and possible requirements in the original condition's final treatment can result from incidentally found enlarged mesenteric lymph nodes (Iqbal et al., 2015).\u003c/p\u003e \u003cp\u003eSurgeons usually detect incidental enlarged mesenteric lymph nodes during laparotomy by palpating and visually inspecting the patient (Zafar et al., 2018). During a standard abdominal cavity examination, these nodes might be observed as well (Unlu et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The size and appearance of the nodes are the main determining factors for enlargement; nodes with a diameter of more than 1 cm are regarded as enlarged (Sando et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Preoperative imaging tests like computed tomography (CT), magnetic resonance imaging (MRI), or intraoperative ultrasonography may occasionally result in incidental discovery (Ezhapilli, S. R., Moreno, C. C., Small, W. C., Hanley, K., Kitajima, H. D., Mittal, 2014; Lu et al., 2020).\u003c/p\u003e \u003cp\u003eIt is important to identify incidental enlarged mesenteric lymph nodes for several reasons. First of all, these nodes' existence can offer crucial diagnostic hints regarding underlying diseases that might not have been recognized in the past (Kavanagh, P. V., Grosskreutz, S. R., Flancbaum, 2019). They might, for instance, point to an underlying infection, inflammatory condition, or cancer, necessitating more investigations and suitable treatment (Maconi, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Second, histological analysis of these nodes can aid in the distinction between benign and malignant lymph node enlargement sources, hence directing further treatment decisions (Corwin et al., 2012). For example, cancer would demand a different therapeutic approach, whereas benign reactive hyperplasia might not require any additional care (Helbling et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo address this challenge, the goal of this study was to provide knowledge on the prevalence, risk factors as well and patterns of incidental mesenteric lymphadenopathy considered to be unusual and requiring additional assessment in addition to providing expert opinion on the management of this condition. Bridging this knowledge gap will also assist in identifying modifiable risk factors for this disorder, which may give clinicians important information on how to lower the risk factors and find the most appropriate treatment.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a hospital-based cross-sectional study and was conducted to assess the Prevalence, Risk Factors, and Histological Pattern of Incidental Enlarged Mesenteric Lymph Nodes in patients requiring emergency laparotomy in central Tanzania, from July 2023 to June 2024. This study was conducted in Dodoma (Benjamin Mkapa Hospital \u0026amp; Dodoma regional referral hospital), and Iringa regional referral hospital. These hospitals serve as referral hospitals in Iringa and Dodoma regions. This study included all candidates who underwent emergency exploratory laparotomy in the respective hospitals. All patients who underwent laparotomy at the respective hospitals, stable patients who could tolerate the procedure, and patients who consented to laparotomy were included in the study. Patients with confirmed Peritoneal Tuberculosis, patients with known abdominal malignancies, and patients with advanced or neglected peritonitis were excluded from the study. In this study, mesenteric lymphadenopathy and histopathological patterns were considered as dependent variables. Exposure variables were Demographic factors and clinical factors. The sample size was calculated using this formula of a single proportion, \u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003ewhere;\u0026nbsp;n = was the minimum sample size required Z = standard normal deviation set at 1.96 (corresponding to a confidence level of 95%),\u0026nbsp;\u0026epsilon;\u0026nbsp;= marginal error to be used of 5.0%,\u003c/p\u003e\n\u003cp\u003eP = prevalence of patients with incidental enlarged mesenteric lymphadenopathy was found to be 38.8%\u0026nbsp;(Islam et al., 2014). Therefore, the proposed sample size was 365 patients. During the study period, 894 patients had exploratory laparotomies in the hospitals where the study was being carried out. 9 patients were excluded from the study (had confirmed malignancies) 885 were recruited. A convenient sampling technique was used. Subjects were selected among and available consented and who had met the inclusion criteria for the study then were enrolled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients\u0026apos; characteristics such as age (years), sex, comorbidities, smoking tendency, preoperative diagnosis, history of medications, fever, weight loss, and history of previous surgeries were obtained directly from the patient.\u0026nbsp;No effort was made to diagnose mesenteric lymphadenopathy preoperative, as these patients were sick requiring emergency surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll patients were resuscitated according to the hospitals\u0026rsquo; protocols until they were hemodynamically stable. They were prepared for surgery, a written informed consent for both an emergency laparotomy and lymph node sampling was obtained. All patients were approached in the same manner, in which, a standard extended midline incision was made; the primary pathology was dealt with according to protocol. After abdominal lavage, the mesentery was thoroughly palpated to identify any enlarged lymph nodes. When found dissection and removal of all nodes more than 1 centimeter in diameter were done,\u0026nbsp;(Sando et al., 2017)\u0026nbsp;using surgical instruments, and the obtained lymph node samples were stored in a sample collection bottle filled with 10% formaldehyde solution for fixing, then transported to the laboratory for histopathological workups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePost-operative, patients were followed for one week to observe for any complications following lymph node dissection such as bleeding, infection, and iatrogenic intestinal perforation. If there were any complications, the patient was managed accordingly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHistological examination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing tissue fixation, the specimen may have required further dissection in the laboratory to obtain an appropriate area for examination. The obtained specimen after dissection underwent the next step called dehydration, where it was immersed in a series of alcohol solutions to remove water from the specimen since the next step in its preparation required no water at all because the paraffin wax used was hydrophobic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe next step in the laboratory was clearing, where a clearing reagent was used to impart optical clarity or transparency to the tissue due to its relatively high refractive index.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe next step was wax infiltration, where a suitable histological wax was used, the last step was tissue embedding or blocking out, in this step, the specimen was formed into a block, which was then clamped into a microtome for section cutting after it was examined for histopathology under a high power field microscope with magnification up to times 400.\u003c/p\u003e\n\u003cp\u003eA tissue biopsy with positive histopathological results suggestive of malignancy was referred to oncologists after surgical resection for further management. For those that were suggestive of any other pathology, patients were subjected to a respective treatment or channeled to a respective department, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe workups were requested by filling out an investigation form and the results were interpreted and attached to a respective document of a patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collected was directly filled into a spreadsheet and checked for correctness and consistency to avoid errors. Descriptive characteristics of the study population, prevalence, and risk factors for MSL were examined using frequency and tables, while numerical variables were summarized as means with standard deviation. The chi-square test of association was used to test the association of the risk factors. Multivariable statistical analysis was used to identify factors associated with incidental mesenteric lymphadenopathy, including the use of regression models to analyze the connection between risk factors and the result of interest. Data was collected and analyzed using Statistical Package for the Social Sciences version 27.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the study period, 894 patients had exploratory laparotomies at the referral hospitals in central Tanzania. 9 patients were excluded from the study (met exclusion criteria) and 885 were recruited. It was discovered that of the 885, 111 of these patients had incidental enlarged mesenteric lymph nodes. It was also seen that, 58.08% of the study group, or most patients, were between the ages of 21 and 40, of the total participants, 633 persons were male, accounting 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. Peasants were found to have mesenteric lymphadenopathy (58.42%) compared to individuals in other occupations, whereby individuals who were self-employed or engaged in business (24.18%), and a very small percentage are employed (1.92%) or unemployed (15.48%).\u003c/p\u003e \u003cp\u003eThe prevalence of mesenteric lymphadenopathy was 12.5%.\u003c/p\u003e \u003cp\u003eHIV was present in a significant portion of individuals (21.60%). It was observed that 3.60% of these patients had hypertension and diabetes mellitus. Smoking was relatively common, with 22.50% of patients having a history of smoking. The vast majority of patients (96.40%) had not had previous abdominal surgery. In this patient population, peritonitis was the most common cause of surgery (87.40% of cases). With 12.60% of cases, intestinal obstruction (IO) was a less frequent surgical indication. 45.90% of the patients had a fever history. Also, 24.30% had weight loss, and 41.40 percent of the patients were taking medications. Other characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the patients undergoing laparotomy found with lymphadenopathy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge categories in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-pastoral tribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePastoral tribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed/business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComorbidities and surgical characteristics of the patients undergoing laparotomy found with lymphadenopathy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical indication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnder sex, there doesn't appear to be a significant association (p\u0026thinsp;=\u0026thinsp;0.9295) between gender and enlarged lymph nodes. In contrast, for variables like Tribes, Occupation, HIV status, Diabetes, Hypertension, history of medication, weight loss, fever, and others, there are significant associations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting these factors may influence the likelihood of incidental enlarged mesenteric lymph nodes.\u003c/p\u003e \u003cp\u003eRegarding tribes, it was observed that among patients with incidentally enlarged mesenteric lymph nodes, patients from non-pastoral tribes have a lower likelihood of having incidental enlarged mesenteric lymph nodes (11.52%) compared to patients from pastoral tribes (28.85%). Regarding occupation of the patients, it was observed that among patients with incidentally enlarged mesenteric lymph nodes, a large proportion were peasants (17.79%) followed by employed (17.65%). Concerning comorbidities, it was observed that among patients with incidentally enlarged mesenteric lymph nodes, a large proportion had comorbidities HIV (43.64%), Diabetes mellitus (44.44%), and Hypertension (44.44%). The findings also showed that among patients with incidental mesenteric lymphadenopathy, a large proportion had a history of fever, using medication, weight loss, and no previous abdominal surgery. Lastly, the results show that among patients with incidental enlarged mesenteric lymph nodes, a large proportion had Peritonitis (18.00%). (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with incidental enlarged mesenteric lymph nodes among patients undergoing laparotomy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo mesenteric lymph\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMesenteric lymph\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChis-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.9295\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220(87.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(12.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e554(87.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79(12.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge categories in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.2250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38(80.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(19.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e457(88.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57(11.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e226(86.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(13.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(83.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(16.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(80.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePastoral tribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37(71.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(28.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-pastoral tribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e737(88.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96(11.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.7712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e425(82.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92(17.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(82.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(17.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed/business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e200(93.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(6.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135(98.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.6896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e743(89.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87(10.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31(56.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(43.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0179*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e769(87.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107(12.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(55.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(44.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0179*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e769(87.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107(12.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(55.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(44.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e764(89.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86(10.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e774(87.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107(12.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical indication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.3848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e332(95.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(4.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e442(82.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97(18.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e774(92.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60(7.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e774(92.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65(7.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e774(90.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84(9.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBinary logistic regression was used to assess the factors associated with incidental enlarged mesenteric lymph nodes. The results show that after controlling for other variables, incidental mesenteric lymphadenopathy was statically significantly associated Non-pastoral tribes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), Peasants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0003), HIV (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001), Diabetes Mellitus (p\u0026thinsp;=\u0026thinsp;0.0356), smoking (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) and surgical indication (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001).\u003c/p\u003e \u003cp\u003eCompared to people from non-pastoral tribes, members of pastoral tribes have a higher percentage of incidentally enlarged mesenteric lymph nodes (AOR\u0026thinsp;=\u0026thinsp;3.112, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). Regarding the occupation of the patients, it was observed that Peasants are more likely to present with incidentally enlarged mesenteric lymphadenopathy (AOR\u0026thinsp;=\u0026thinsp;16.460, p\u0026thinsp;=\u0026thinsp;0.0003) compared to other patients. The findings also show that HIV-positive patients are more likely to have incidental mesenteric lymphadenopathy (AOR\u0026thinsp;=\u0026thinsp;7.057, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) compared to those with no HIV. In addition to that, diabetic patients were more likely to have incidental enlarged mesenteric lymph nodes (AOR\u0026thinsp;=\u0026thinsp;6.564, p\u0026thinsp;=\u0026thinsp;0.0356) compared to non-diabetic patients. Smoking patients are more likely to have incidental mesenteric lymphadenopathy (AOR\u0026thinsp;=\u0026thinsp;10.324, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) compared to non-smokers. The findings show that Peritonitis patients were more likely to have incidental enlarged mesenteric lymph nodes (AOR\u0026thinsp;=\u0026thinsp;3.930, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) compared to Intestinal obstruction patients. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression for the factors associated with incidental enlarged mesenteric lymph nodes among patients undergoing laparotomy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUNADJUSTED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eADJUSTED\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-pastoral tribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePastoral tribes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.112[1.647,5.882]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.112[1.647,5.882]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.612[3.552,60.100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.460[3.675,73.720]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.464[2.225,94.026]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.921[0.301,28.357]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed/business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.725[1.057,21.125]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.985[0.808,19.665]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0896\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.612[3.712,11.777]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.057[2.975,16.741]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.750[1.520,21.745]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.564[1.135,37.945]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0356\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.750[1.520,21.745]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.541[0.053,5.540]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.198[10.315,47.772]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.324[3.745,28.458]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical indication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.204[2.919,9.278]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.930[2.040,7.572]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the incidental lymphadenopathy (N\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of incidental enlarged mesenteric lymph nodes\u003c/h2\u003e \u003cp\u003eThe prevalence of incidental mesenteric lymphadenopathy of 12.5% in this study differs from the study by Vayner et al., (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) which showed the prevalence of mesenteric lymphadenopathy to be 61.4%, Gawad et al., (2016), found a slightly higher prevalence of 68% while Unlu et al., (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) reported a lower prevalence of 7%. In all studies, patients were characteristically different from the index study explaining the differences, while in the study by Vayner, the methodology included only children, possibly increasing the prevalence. Comparatively speaking, our study and the others' findings are comparable in that mesenteric lymphadenopathy was more common in the male gender in both studies (Vayner et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence in this study also differs from another study done in children, whereby a higher prevalence of 61.4% of enlarged mesenteric lymph nodes was observed in children involved in the study (Gross et al., 2017). The higher prevalence difference could be because mesenteric lymphadenopathy is a more common finding in children than the adult population which was most common in our study population (Sahar Javed et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother higher prevalence of mesenteric lymph node enlargement was in 72.1% of the cases and 13.4% of controls in Sri Lanka in children who presented with chronic abdominal pain (Balakrishnan et al., 2018). This differs from our study probably due to the differences in the study population. Unlike our adult study population, it is similar to our study that lymphadenopathy was prevalent in the male gender same as in our study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with incidental enlarged mesenteric lymph nodes:\u003c/h2\u003e \u003cp\u003eThe nomadic pastoral tribes were the most afflicted group in the study population, a statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) difference, which may have been caused by several elements inherent in their way of life and cultural customs. Katale et al., (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) indicated that Maasai people who are nomadic pastoralists are at considerable risk due to their custom of consuming raw milk, which puts them at risk for diseases like tuberculosis (TB). Bovine \u003cem\u003emycobacterium bovis\u003c/em\u003e is a species of bacteria that can cause tuberculosis (TB) in humans when consumed through unpasteurized dairy products (Bola\u0026ntilde;os et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Nomadic pastoralism is a factor associated with several diseases, in a study regarding epidemic-prone diseases among pastoralists in Uganda, it was revealed that nomadic pastoralism is a factor associated with the occurrence and reoccurrence of epidemic diseases (Cummings et al., 2014). These similarities with the index study are probably due to the similar manner of living among pastoral tribes.\u003c/p\u003e \u003cp\u003eCompared to other occupational groups, peasants, or those involved in manual labor and small-scale farming, were shown to have a higher incidence of incidentally enlarged mesenteric lymph nodes. Dwivedi et al., (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) indicated that lower socioeconomic position is frequently associated with inferior living circumstances, inadequate nutrition, and restricted access to healthcare which put one at greater risk for infections and other illnesses that might lead to lymphadenopathy, consistent with the findings of this study. The danger may be further increased by the physically demanding nature of peasants and possible exposure to environmental infections as shown by Donnelly et al., (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) that there is an association between low socioeconomic status and increased risks of infection and hospitalization in people of low socioeconomic status such as peasants in the index study. These studies are in line with the index study possibly because peasants in this study are from poor socioeconomic societies.\u003c/p\u003e \u003cp\u003eIncidental enlarged mesenteric lymph nodes were more common in patients whose surgical indication was peritonitis. This finding is similar to a study by Felten et al., (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), that indicated peritoneal contamination by intestinal contents can result in mesenteric lymphadenopathy. The relationship between peritonitis and lymph node enlargement is highlighted by the inflammatory process as well as the presence of bacteria or other irritants in the abdominal cavity which is the site of a possible intermediate phase in the immune response (Malbon et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This is in line with the index study possibly because most patients being attended at these referral facilities have neglected peritonitis warranting prolonged exposure to irritants in the abdominal cavity leading to mesenteric lymphadenopathy.\u003c/p\u003e \u003cp\u003eIn the index study, incidental enlarged mesenteric lymph nodes were more common in patients with comorbidities, such as HIV and diabetes than in patients without these illnesses. A similar observation was seen in one study that indicated HIV was a risk factor for developing mesenteric lymphadenopathy (Javed et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). It is known that HIV is an immune system-attacking virus, increasing susceptibility to infections, including those that might result in lymphadenopathy as reported by Deeks et al., (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and Taramasso et al., (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Similar to this, diabetes weakens the immune system and makes people affected more prone to infections (Berbudi et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jwad \u0026amp; Al-Fatlawi, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Enlarged lymph nodes are more common in the immunocompromised, which can be explained by the chronic nature of these diseases and their effect on the body's defenses against infections (Lucas, 2017). These studies support the findings of the index study perhaps as a consequence of the immunosuppressive nature of these comorbidities.\u003c/p\u003e \u003cp\u003eThis study revealed smoking is a significant risk factor, with smokers having an increased likelihood of incidentally enlarged mesenteric lymph nodes compared to non-smokers. Similarly, in one study on mesenteric lymphadenitis as a presenting feature of Whipple's disease, smoking was also found to be one of the risk factors (Chizinga et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The difference with the index study is that only patients with Whipple's disease were recruited. Yamaguchi et al., (2019) indicated that the immune system is known to be negatively impacted by smoking, and one of these impacts is that it hinders the body's capacity to mount efficient defenses. Similarly, Jiang et al., (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) indicated that smokers may be more vulnerable to infections and inflammatory diseases that cause lymph node enlargement as a result of this immunosuppressive effect. Furthermore, smoking has been linked to long-term respiratory disorders, which may have an indirect impact on the lymphatic system and how it functions (Margaritopoulos et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The above studies are in line with the index study\u0026rsquo;s findings perhaps because smokers are prone to immunosuppression which makes them susceptible to abdominal infections and consequently mesenteric lymphadenopathy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eHistological pattern of incidental enlarged mesenteric lymph nodes\u003c/h2\u003e \u003cp\u003ePathological investigation of the 111 patients with incidentally enlarged mesenteric lymph nodes showed a varied pattern of underlying diseases. Interestingly, Tuberculous granulomatous lesions were present in 26 patients (23.42%), a strong diagnostic of peritoneal tuberculosis (TB). In line with the index study, a prevalence of 31\u0026ndash;58% of abdominal TB was reported by Rossi et al., (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The similarity to the index study is that the cohort involved was from a developing country. The index study is also in line with a study that was done in India that indicated Tuberculous lymphadenopathy being the commonest form of abdominal TB showing the importance of thorough investigations when mesenteric lymphadenopathy is noted (Govil et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Fillion et al., (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) reported a higher prevalence of 67% of peritoneal TB in their study that aimed to describe the characteristics and treatment of patients presenting with abdominal tuberculosis. This differs from our study probably because a smaller number of patients (21) were included in their study.\u003c/p\u003e \u003cp\u003eOn the other hand, it was discovered that 10 individuals (9.01%) had cancer linked to their enlarged mesenteric lymph nodes. Lucey B.C et al., (2005) indicated that colorectal cancer and pancreatic carcinoma are frequently associated with local mesenteric lymphadenopathy in line with this study giving a clue that enlarged mesenteric lymph nodes should be investigated. Given that malignancies might have substantial prognostic and therapeutic implications, this subgroup is an important component of incidental findings during laparotomies (Kang et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Primary tumors arising in the mesenteric lymph nodes as well as secondary metastatic lesions are among the types of malignancies found incidentally during laparotomy (Dufay et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The identification of mesenteric lymphadenopathy incidentally emphasizes the necessity of close observation and a comprehensive histological assessment of the mesenteric lymph nodes to guarantee an early and precise cancer diagnosis (Moos et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Same as in the index study, both primary and secondary mesenteric tumors were observed necessitating the importance of histological examination.\u003c/p\u003e \u003cp\u003eReactive mesenteric lymph nodes were present in 52 patients (46.84%) of the total number of patients. Usually, reactive lymphadenopathy is an indication of a benign condition that is occurring elsewhere in the body, such as an infection or inflammation that does not need surgery (Helbling et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, it is important to further investigate the reactive lymph histological pattern (Tzankov \u0026amp; Dirnhofer, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). To distinguish between more dangerous illnesses that may first present similarly and benign reactive alterations, it is imperative to identify and closely monitor these patients with reactive lymphadenopathy (Tzankov \u0026amp; Dirnhofer, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, the mesenteric lymph nodes of 23 individuals (20.72%) showed signs of chronic nonspecific inflammation which are non-specific hyperplasia and edema. Patients with long-term inflammatory diseases including Crohn's disease, ulcerative colitis, and other types of inflammatory bowel disease (IBD) usually present with this lymph node pattern (Unlu et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Significant lymph node enlargement caused by mesentery inflammation may be symptomatic or incidentally detected (Helbling et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Treating the underlying inflammatory illness in these patients entails using biological medicines, immunosuppressants, and corticosteroids (Maconi, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Monitoring closely and following up often are necessary to control illness flare-ups and avoid consequences (Dwivedi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese results demonstrate the diversity and intricacy of incidental mesenteric lymphadenopathy. Granulomatous, malignant, reactive, and inflammatory patterns all call for different approaches to diagnosis and treatment (Koo, H., Jang, H., Kim, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It is impossible to exaggerate the significance of carefully examining incidental findings made during laparotomies since doing so makes it possible to identify potentially dangerous underlying diseases that could otherwise go undetected in line with another study (Tzankov \u0026amp; Dirnhofer, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo guarantee thorough assessment and the best possible patient care, cooperation between surgeons, pathologists, infectious disease specialists, oncologists, and gastroenterologists is essential. Better patient outcomes, proper therapy, and accurate diagnosis are made possible by this integrated approach (Bayramoğlu et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEnlarged mesenteric lymph nodes found incidentally during laparotomy indicate an ongoing infection or pathology that needs attention. Therefore, thorough investigations should be done 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 complications, longer hospital stays, and dangerous outcomes for patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBenjamin Mkapa Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDRRH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDodoma Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntestinal obstruction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIRRH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIringa Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from The Dodoma University Research Review Ethics Committee. All participants who accepted to be recruited in the study signed a written consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003enot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternal Review Board:\u0026nbsp;\u003c/strong\u003eThe Dodoma University Research Review Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ehttps://drive.google.com/file/d/1RRLywumudIY3iNzDf1nvfRYZWPrersew/view?usp=sharing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources\u003c/strong\u003e: Personal funds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDR-\u003c/strong\u003e conception and design of the study, acquisition, and analysis of data, drafting the manuscript, and submission of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMYM-\u0026nbsp;\u003c/strong\u003econception and design of the study, acquisition, and analysis of data, finalizing of the manuscript and correspondence.\u003c/p\u003e\n\u003cp\u003eAll authors hereby declare that they read and approved the final manuscript before submission for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the contributions of Mr. and Mrs. Josephat Rweyemamu and Dr. Francis Zerd for their endless support throughout this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbdel Gawad, E. A., Abu Samra, M. F., \u0026amp; Talat, A. M. (2016). The utility of multi-detector CT in detection and characterization of mesenteric lymphadenopathy with histopathological confirmation. \u003cem\u003eEgyptian Journal of Radiology and Nuclear Medicine\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(3), 757\u0026ndash;764. https://doi.org/10.1016/j.ejrnm.2016.06.020\u003c/li\u003e\n \u003cli\u003eBayramoğlu, Z., Yılmaz, R., Demir, A. A., Ataizi-\u0026Ccedil;elikel, \u0026Ccedil;., Kombak, F. E., İkinci, A., \u0026amp; Yekeler, E. (2019). Multimodality imaging findings of visceral myopathy in a child presenting with palpable abdominal mass. \u003cem\u003eThe Turkish Journal of Pediatrics\u003c/em\u003e, \u003cem\u003e61\u003c/em\u003e(1), 120\u0026ndash;125.\u003c/li\u003e\n \u003cli\u003eBerbudi, A., Rahmadika, N., Tjahjadi, A. I., \u0026amp; Ruslami, R. (2020). 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A., Vasarmidi, E., Jacob, J., Wells, A. U., \u0026amp; Antoniou, K. M. (2015). Smoking and interstitial lung diseases. \u003cem\u003eEuropean Respiratory Review\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(137), 428\u0026ndash;435.\u003c/li\u003e\n \u003cli\u003eMendiratta, P., Rai, A. K., \u0026amp; Sharma, R. (2023). Prevalence and Significance of Mesenteric Lymphadenopathy in Children with Functional Abdominal Pain Disorder-Not Otherwise Specified: A Novel Ultrasonography based Retrospective Case Control Study. \u003cem\u003eTropical Gastroenterology\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(4), 204\u0026ndash;209.\u003c/li\u003e\n \u003cli\u003eMohammed, H., Assefa, N., \u0026amp; Mengistie, B. (2018). Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis. \u003cem\u003eHIV/AIDS-Research and Palliative Care\u003c/em\u003e, 225\u0026ndash;237.\u003c/li\u003e\n \u003cli\u003eMoos, V., von Lampe, B., \u0026amp; Schneider, T. (2024). Massive Mesenteric Lymphadenopathy: An Unusual Outcome. \u003cem\u003eGastroenterology\u003c/em\u003e, \u003cem\u003e166\u003c/em\u003e(5), e5\u0026ndash;e9. https://doi.org/https://doi.org/10.1053/j.gastro.2023.11.040\u003c/li\u003e\n \u003cli\u003ePapoutsopoulou, S., Satsangi, J., Campbell, B. J., \u0026amp; Probert, C. S. (2020). impact of cigarette smoking on intestinal inflammation\u0026mdash;direct and indirect mechanisms. \u003cem\u003eAlimentary Pharmacology \u0026amp; Therapeutics\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(12), 1268\u0026ndash;1285.\u003c/li\u003e\n \u003cli\u003eRaju Sharma, M. K. S., \u0026amp; Kandasamy, D. (2019). 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The utility of diagnostic laparoscopic biopsy for mesenteric and retroperitoneal lymph nodes. \u003cem\u003eThe American Journal of Case Reports\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e, 878.\u003c/li\u003e\n \u003cli\u003eSingh, I. K. (2020). Mesenteric lymphadenopathy: A common cause of chronic abdominal pain in children. \u003cem\u003eInternational Journal\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 28.\u003c/li\u003e\n \u003cli\u003eTaramasso, L., Tatarelli, P., \u0026amp; Di Biagio, A. (2016). Bloodstream infections in HIV-infected patients. \u003cem\u003eVirulence\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(3), 320\u0026ndash;328.\u003c/li\u003e\n \u003cli\u003eTzankov, A., \u0026amp; Dirnhofer, S. (2018). A pattern-based approach to reactive lymphadenopathies. \u003cem\u003eSeminars in Diagnostic Pathology\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(1), 4\u0026ndash;19.\u003c/li\u003e\n \u003cli\u003eUnlu, E., Okur, N., Acay, M. B., Kacar, E., Ozdinc, S., Balcik, C., \u0026amp; Tokgoz, O. T. (2016). The Prevalence of Incidentally Detected Idiopathic Misty Mesentery on Multidetector Computed Tomography: Can Obesity Be the Triggering Cause? \u003cem\u003eCanadian Association of Radiologists Journal\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e(3), 212\u0026ndash;217. https://doi.org/10.1016/j.carj.2015.06.004\u003c/li\u003e\n \u003cli\u003eVayner, N., Coret, A., Polliack, G., Weiss, B., \u0026amp; Hertz, M. (2003). Mesenteric lymphadenopathy in children examined by US for chronic and/or recurrent abdominal pain. \u003cem\u003ePediatric Radiology\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(12), 864\u0026ndash;867. https://doi.org/10.1007/s00247-003-0985-7\u003c/li\u003e\n \u003cli\u003eYamaguchi, N. H. (2019). Smoking, immunity, and DNA damage. \u003cem\u003eTranslational Lung Cancer Research\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(Suppl 1), S3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Incidental, mesenteric lymph node, enlargement","lastPublishedDoi":"10.21203/rs.3.rs-4943758/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4943758/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology: \u003c/strong\u003eThe 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 \u0026lt; 0.05, to determine the factors linked to lymph node enlargement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIt 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\u0026lt;.0001)], [smoking (71.43%), and (p\u0026lt;.0001)], [nomadic pastoralism (28.85%) (p\u0026lt;.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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation: \u003c/strong\u003eThe 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,\u003cstrong\u003e \u003c/strong\u003epreoperative 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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-04 10:06:05","doi":"10.21203/rs.3.rs-4943758/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-30T13:54:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-26T11:03:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272467097266593663707437435243794565299","date":"2024-09-18T13:00:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-12T14:54:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49948834632803539919278124011398669761","date":"2024-09-05T11:52:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-05T11:48:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-03T12:24:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-03T05:04:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-03T05:04:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2024-08-20T09:21:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"804aa264-72fb-4cef-937a-8b9f86120497","owner":[],"postedDate":"October 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-17T16:04:22+00:00","versionOfRecord":{"articleIdentity":"rs-4943758","link":"https://doi.org/10.1186/s12893-024-02745-0","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-02-11 15:57:08","publishedOnDateReadable":"February 11th, 2025"},"versionCreatedAt":"2024-10-04 10:06:05","video":"","vorDoi":"10.1186/s12893-024-02745-0","vorDoiUrl":"https://doi.org/10.1186/s12893-024-02745-0","workflowStages":[]},"version":"v1","identity":"rs-4943758","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4943758","identity":"rs-4943758","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}