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Henoch-Schönlein disease localized in the appendix
S M M de Castro1, P Joosse, C Unlü
1Department of Surgery, Saint Lucas Andreas Hospital, Amsterdam, The Netherlands, stevedecastro@me.com.
Indian Journal of Pediatrics
|January 1, 2013
Summary
A 16-year-old boy with acute abdomen symptoms was diagnosed with Henoch-Schönlein disease after appendicitis surgery revealed unusual findings. This case highlights the importance of considering systemic vasculitis in abdominal emergencies.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Rheumatology
Background:
- Acute abdomen in adolescents often suggests appendicitis, necessitating prompt surgical evaluation.
- Henoch-Schönlein disease (HSP) is a common childhood vasculitis, typically presenting with rash, arthritis, abdominal pain, and kidney disease.
- Gastrointestinal manifestations of HSP can mimic surgical emergencies, posing diagnostic challenges.
Observation:
- A 16-year-old male presented with acute abdominal pain, initially suspected as acute appendicitis based on ultrasonography.
- Intraoperative findings revealed appendiceal and terminal ileum abnormalities suggestive of vasculitis, atypical for simple appendicitis.
- Postoperative development of purpura and arthralgia confirmed Henoch-Schönlein disease.
Findings:
- Histopathological examination of the appendix and skin biopsy confirmed leukocytoclastic vasculitis, characteristic of HSP.
- The appendix displayed a distal end with a red, vasculitis-like appearance.
- A circular, vasculitis-like red band was noted in the terminal ileum during surgery.
Implications:
- This case underscores the critical need to consider systemic vasculitis, such as Henoch-Schönlein disease, in the differential diagnosis of acute abdomen in pediatric patients.
- Early recognition and appropriate management of HSP can prevent complications and guide surgical decision-making.
- Highlighting the diverse gastrointestinal presentations of HSP is crucial for pediatric surgeons and gastroenterologists.
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