Spontaneous intestinal perforation in Schönlein-Henoch purpura

Schönlein-Henoch purpura (SHP) continues to present diagnostic and therapeutic challenges to internists and to surgeons. Indications for operation in this entity are solely for intussusception, ischemic bowel necrosis, and frank bowel perforation. We present two recent cases of spontaneous small bowel perforation in SHP and analyze the previously reported cases. Spontaneous intestinal perforation is often heralded by increase in rectal blood loss, even frank melena, and a worsening or unresponsive abdominal picutre such as progressive distention and loss of bowel sounds. Perforations, usually ileal, may be accompanied by intussusception.