Sonographic evaluation of the abdomen in Henoch-Schonlein purpura

This study evaluates the role of ultrasound in the monitoring of abdominal symptoms of Henoch-Schonlein purpura. Clinical and radiological records of patients with gastrointestinal symptoms necessitating ultrasound scans were reviewed. Forty-four patients attended The Children's Hospital, Dublin, between August 1989 and December 1992, 15 (34%) of whom had abdominal ultrasound scans. There were 13 boys and two girls, ranging in age from 3.75 to 13.5 years. Abdominal radiographs in 13 patients did not add any significant information. Ultrasound detected thickened bowel wall in all 15 patients (0.4-1.1 cm), free peritoneal fluid in 10, ileus of affected loops in five, and bowel dilatation in eight. Serial ultrasound examinations in 12 patients followed the progress of bowel involvement, with resolution of mural thickening, return of peristalsis, reduction in ascites and bowel dilatation. There were seven intussusceptions in five patients, measuring 2.18-7.4 cm, which were documented as loose in four (i.e. where air or fluid lay between the intussusceptum and the intussuscipiens). Surgery was performed in three patients in the earlier years of the study; serial ultrasound monitoring has enabled a more conservative approach to be adopted in the latter years of the study. We conclude that ultrasound is the imaging modality of choice in evaluating the bowel manifestations of Henoch-Schonlein purpura. It provides an easy, noninvasive, objective method of monitoring patient progress. It allows direct visualization of bowel involvement and detection of complications such as intussusception. Routine abdominal radiographs are not recommended, unless perforation is clinically suspected.