Clinical characteristics and associating risk factors of gastrointestinal perforation in children with IgA vasculitis

Abstract

Background IgA vasculitis (IgAV) is a common small vessel vasculitis in children. Gastrointestinal perforation (GP) rarely presents as a complication of IgAV and is not well characterized. This study is aimed to investigate the clinical features, diagnosis, and risk factors of GP in children with IgAV. Methods We retrospectively reviewed the clinical data of children with IgAV who attended our hospital between January 2014 and June 2018. The clinical risk factors and the corresponding treatments were analyzed for the children with IgAV complication with GP. Results In total, 10,791 children with IgAV were reviewed in this study. GP was observed in 11 children with IgAV, accounted for 0.10% of the total cases. Among those GP patients, 1 case was gastric perforation, 10 cases were intestinal perforation. Five GP cases were identified by abdominal CT. Ultrasonography was failed to detect the occurrence of GP in five cases. The average duration of abdominal pain in the GP cases was 9.3 days, and 9 cases (81.8%) presented with abdominal pain for over 7 days. Gastric/intestinal perforation repair were performed for 3 IgAV GP cases under open surgery. The other eight cases were treated through enterectomy. In comparison with the patients without GP, the GP patients had significant higher rates in the aspect of the abdominal or mixed type of IgAV, abdominal pain duration more than 7 days, hematochezia, renal damage, and methylprednisolone treatment with the daily dosage more than 2 mg/kg. Conclusion GP children accounted for 0.10% of the total IgAV cases. The risk of GP is elevated in IgAV patients who has gastrointestinal symptoms and/or other symptoms such as hematochezia, renal damage, a prolonged abdominal pain (>7 days), administration of methylprednisolone (>2 mg/kg). Abdominal CT is highly recommended for the early detection of GP in IgAV patients. Key messages Gastrointestinal perforation (GP) rarely presents as a complication of IgAV and is not well characterized. 11 out of 10,791 children with IgAV developed GP, accounting for 0.10% of the total number of cases. Abdominal CT is highly recommended for the early detection of GP in IgAV patients.

Evaluation of Gastrointestinal Manifestations and Predictive Factors in Pediatric Henoch-Schönlein Purpura

“…Guo et al's study did not discuss laboratory data as risk factors for GI bleeding or gastrointestinal perforation, focusing instead on the importance of history taking, past medical history, and findings from physical examinations (13). In contrast, our study analyzed both clinical and paraclinical data, representing a specific strength of our research.…”

“…In 2021, Guo et al published research focusing on the clinical characteristics and risk factors of gastrointestinal perforation in children with small vessel vasculitis (13). Their retrospective study analyzed a cohort of 10,971 children with HSP from 2014 to 2018.…”

Multidrug-resistant IgA Vasculitis with Gastrointestinal Symptoms Successfully Treated with Intravenous Cyclophosphamide and Maintained with Mycophenolate Mofetil

“…Guo et al reviewed 10,791 children with IgAV and retrospectively analyzed the risk of gastrointestinal perforation, which occurred in 11 cases (0.1%). Prolonged abdominal pain (>7 days) and the administration of methylprednisolone (>2 mg/kg) were related to an increased risk of gastrointestinal perforation ( 9 ). A case-control study of 60 children with IgAV revealed 4 independent risk factors for intussusception in pediatric IgAV with GI involvement: age at onset, not receiving glucocorticoid therapy within 72 hours of the emergence of GI symptoms, positive stool blood test, and elevated D-dimer levels ( 10 ).…”

Immunological Features of Children with Gastrointestinal Bleeding Due to Henoch-Schönlein Purpura

“…19 Additionally, an abdominal pain duration of more than seven days and a methylprednisolone dose of over 2 mg/kg increased gastrointestinal perforation in children with HSP. 20 The HSP in children with intermittent abdominal pain had a high risk of nephritis and severe GI bleeding. These patients should be followed up strictly with clinical and laboratory assessments, mainly during the first month of the disease course.…”