Henoch-Schönlein Purpura With Intussusception: A Case Report

Received 7 March 2009; received in revised form 22 May 2009; accepted 4 June 2009.

Gastrointestinal symptoms in Henoch-Schönlein purpura (HSP) are common and occur in about two-thirds of HSP patients. Surgical intervention is only required in a minority of cases. Intussusception is a rare complication and the most common surgical indication for HSP. We report a 3-year-old boy with HSP and clinical manifestations of palpable skin rash lasting for 4 days, fever for 3 days, intermittent abdominal cramping pain, and left ankle arthralgia lasting for several hours. Abdominal sonography revealed characteristic signs of intussusception including a doughnut sign and a pseudo-kidney sign in the right upper quadrant of the abdomen. After unsuccessful initial reduction by air enema, surgical reduction was arranged and manual reduction of the ileocecal intussusception without bowel resection was carried out.

Key Words: anaphylactoid purpura , intussusception

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References

1. 1 Choong CK , Kimble RM , Pease P , Beasley SW . Colic-colic intussusception in Henoch-Schonlein purpura . Pediatr Surg Int . 1998;14:173–174 . MEDLINE | CrossRef

2. 2 Yang YH , Hung CF , Hsu CR , et al. A nationwide survey on epidemiological characteristics of childhood Henoch-Schönlein purpura in Taiwan . Rheumatology . 2005;44:618–622 . MEDLINE | CrossRef

3. 3 Glasier CM , Siegel MJ , McAlister WH , Shackelford GD . Henoch-Schönlein syndrome in children: gastrointestinal manifestation . AJR Am J Roentgenol . 1981;136:1081–1085 .

4. 4 Chang WL , Yang YH , Lin YT , Chiang BL . Gastrointestinal manifestations in Henoch-Schönlein purpura: a review of 261 patients . Acta Paediatrica . 2004;93:1427–1431 .

5. 5 Chen SY , Kong MS . Gastrointestinal manifestations and complications of Henoch-Schönlein purpura . Chang Gung Med J . 2004;27:175–181 .

6. 6 Ebert EC . Gastrointestinal manifestations of Henoch-Schönlein purpura . Dig Dis Sci . 2008;53:2011–2019 . CrossRef

7. 7 Saulsbury FT . Henoch-Schönlein purpura in children: report of 100 patients and review of the literature . Medicine (Baltimore) . 1999;78:395–409 . MEDLINE | CrossRef

8. 8 Martinez-Frontanilla LA , Haase GM , Ernster JA , Bailey CW . Surgical complications in Henoch-Schönlein purpura . J Pediatr Surg . 1984;19:434–436 . Abstract | CrossRef

9. 9 Mir E . Surgical complications in Henoch-Schönlein purpura in childhood . Z Kinderchir . 1988;43:391–393 . MEDLINE

10. 10 Diaz MC , Ramundo ML , Christopher NC . Spontaneous reduction of a small bowel intussusception in a patient with Henoch Schönlein purpura . Am J Emerg Med . 2004;22:323–325 . Full Text | Full-Text PDF (202 KB) | CrossRef

11. 11 Schwab J , Benya E , Lin R , Majd K . Contrast enema in children with Henoch-Schönlein purpura . J Pediatr Surg . 2005;40:1221–1223 . Abstract | Full Text | Full-Text PDF (69 KB) | CrossRef

12. 12 Hu SC , Feeney MS , McNicholas M , O'Halpin D , Fitzgerald RJ . Ultrasonography to diagnose and exclude intussusception in Henoch Schönlein purpura . Arch Dis Child . 1991;66:1065–1067 . CrossRef

13. 13 Kornecki A , Daneman A , Navarro O , Connolly B , Manson D , Alton DJ . Spontaneous reduction of intussusception: clinical spectrum, management and outcome . Pediatr Radiol . 2000;30:58–63 . MEDLINE | CrossRef

14. 14 Ronkainen J , Koskimies O , Ala-Houhala M , et al. Early prednisone therapy in Henoch-Schönlein purpura: a randomized, double-blind, placebo-controlled trial . J Pediatr . 2006;149:241–247 . Abstract | Full Text | Full-Text PDF (328 KB) | CrossRef

15. 15 Huber AM , King J , McLaine P , Klassen T , Pothos M . A randomized, placebo-controlled trial of prednisone in early Henoch Schönlein purpura . BMC Medicine . 2004;2:7 . MEDLINE | CrossRef

16. 16 Li WC , Ko SF , Kuo HW , Huang SC , Liang CD , Tiao MM . Different management options for anaphylactoid purpura with intussusception: a case report . Acad Emerg Med . 2001;8:1005–1007 . MEDLINE | CrossRef

17. 17 Martinez-Frontanilla LA , Silverman L , Meagher DP . Intussusception in Henoch-Schönlein purpura: diagnosis with ultrasound . J Pediatr Surg . 1988;23:375–376 . MEDLINE | CrossRef

18. 18 Couture A . Evaluation of abdominal pain in Henoch-Schönlein syndrome by high frequency ultrasound . Pediatric Radiology . 1992;22:12–17 . MEDLINE | CrossRef

Department of Pediatrics, Show Chwan Memorial Hospital, Chang-Hwa, Taiwan

Corresponding author. Department of Pediatrics, Show Chwan Memorial Hospital, 542 Chung-Shan Road, Section 1, Chang-Hwa, Taiwan

PII: S1875-9572(10)60013-7

doi:10.1016/S1875-9572(10)60013-7

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