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Intra-abdominal manifestations of Henoch-Schönlein purpura
1Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
Insights
Gastrointestinal issues are common in Henoch-Schönlein Purpura (HSP), often presenting as abdominal pain. Ultrasonography is key for diagnosing complications like intussusception, improving outcomes and reducing unnecessary surgeries.
Area of Science:
- Pediatric Gastroenterology
- Rheumatology
- Diagnostic Imaging
Background:
- Henoch-Schönlein Purpura (HSP) frequently involves the gastrointestinal tract in children, with abdominal pain being a common symptom.
- Gastrointestinal symptoms can precede the characteristic rash, mimicking surgical emergencies and leading to misdiagnosis.
Purpose of the Study:
- To highlight the prevalence and spectrum of gastrointestinal involvement in pediatric HSP.
- To emphasize the diagnostic utility of ultrasonography for intra-abdominal complications, particularly intussusception.
- To underscore the impact of early diagnosis and treatment on reducing mortality.
Main Methods:
- Review of clinical presentations and diagnostic approaches for gastrointestinal complications in HSP.
- Emphasis on the role of ultrasonography as the primary imaging modality.
- Analysis of complication rates and outcomes with timely intervention.
Main Results:
- Approximately two-thirds of children with HSP experience gastrointestinal involvement, primarily abdominal pain.
- Intussusception is the most frequent major complication, often confined to the small bowel.
- Ultrasonography is superior to contrast enema for diagnosing intussusception in HSP.
- Early diagnosis and prompt management have drastically reduced mortality from 40% to nearly zero.
Conclusions:
- Gastrointestinal manifestations are a significant feature of pediatric HSP, requiring careful evaluation.
- Ultrasonography is the investigation of choice for diagnosing intra-abdominal complications, especially intussusception.
- Timely diagnosis and treatment of abdominal complications in HSP are crucial for preventing severe outcomes and mortality.
Abstract:
Gastrointestinal involvement occurs in approximately two thirds of children with Henoch-Schönlein Purpura (HSP) and usually is manifested by abdominal pain. Abdominal symptoms precede the typical purpuric rash of HSP in 14-36%; the symptoms may mimic an acute surgical abdomen and result in unnecessary laparotomy. Major complications of abdominal involvement develop in 4.6% (range 1.3-13.6%), of which intussusception is by far the most common. The intussusceptum is confined to the small bowel in 58%; its frequent inaccessibility to demonstration by contrast enema means that ultrasonography is the investigation of choice. Ultrasonography complements serial clinical assessment, clarifies the nature of the gastrointestinal involvement and reduces the likelihood of unnecessary surgery. Bowel ischaemia and infarction, intestinal perforation, fistula formation, late ileal stricture, acute appendicitis, massive upper gastrointestinal haemorrhage, pancreatitis, hydrops of the gallbladder and pseudomembranous colitis are seen infrequently. Earlier diagnosis and prompt treatment of intra-abdominal complications has reduced the mortality from 40% to almost zero.