Chronic Intestinal Obstruction Following Henoch-Schönlein Disease

Abstract

EI~OGH-SCI~(3i'~I,~Ii~1 disease is a well recognized pitfall in the differential diagnosis of acute abdominal emergencies. In reviewing the alimentary lesions in this disorder Balf (1951) concluded-&dquo; they appear to be of transitory importance only and there is no record of progression to chronic disease of the bowel.&dquo; The rarity of surgical complications has been confirmed by Phelan (1961). The following case appears to be the first full account in the English literature describing chronic small bowel obstruction after an attack of HenochSch6filein purpura. CASE .~'I~S ~'t~ ~R ~rA five-year-old boy was admitted April 14, 1962 with a history of pain in both knees for three days and pain in the abdomen and lumbar area commencing on the day of admission. Lumbar pain was the most striking symptom; any back movement caused the child to scream. He had no serious illness in the past. In the two months preceding admission he had intermittent attacks of abdominal pain and vomiting but on each occasion had completely recovered within 24 hours. At no time prior to admission had his abdomen been distended.On admission. He was a thin boy; temperature 99.4' F.; pulse rate 124/min.; respiration rate 2fiJ . min. He did not appear very ill yet resented any movement and all attempts at examination. Both knees and the right arm, especially in the elbow region, were swollen. There was a swelling over the dorsi-lumbar region of the spine with marked tenderness and rigidity.A clinical diagnosis of osteitis was made and penicillin therapy commenced. Investigations performed on admission wereHb.-10~~j~. 6V.B.C.-16,O~OJcu. mm. E.S.R.-5 mm. in 1st hour, 18 mm. in 2nd hour.Blood culture-----ne~ative. X-ray of right humerus and elbow and of spine -no abnormality noted other than soft tissue swelling around elbow joint. The following day he seemed a little better but his eyes were puffy and he passed a large, dark, loose stool. It was presumed to contain blood but was disposed of before this was confirmed. W.B.C.were now 13,000/cu. mm. E.S.R. 18 mm. in 1st hour, 45 mm. in 2nd hour.That night, i.e., 30 hours after admission, the child passed dark urine due to gross hematuria (prior to this there had been none). He also developed a purpuric rash over the buttocks, making the correct diagnosis obvioiis-Hefioch-Sch6nlein disease. During the next 12 hours he complained frequently of abdominal pain and had tenderness in the left side of the abdomen but no palpable mass. Radiography of abdomen showed fullness in the left flank (? extraperitoneal hematoma) but the distribution of gas in the abdomen was within normal limits.He was then transferred to the medical wards under the care of Dr. R. A. Shanks. He continued to have intermittent colicky abdominal pain and vomiting, occasional low grade fever, hematuria, proteinuria and positive tests for fecal occult blood at University of Manitoba Libraries on June 16, 2015 cpj.sagepub.com Downloaded from