CT demonstration of gastrointestinal involvement in Henoch-Schonlein syndrome

Siskind, Barry N.; Burrell, Morton I.; Pun, Hector; Russo, R; Levin, Wayne

doi:10.1007/bf01893130

Cited by 24 publications

(11 citation statements)

References 2 publications

(1 reference statement)

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“…Engorgement of mesenteric vessels adjacent to the involved bowel loops appears as prominent enhancing tubular structures within the mesenteric fat. There may be luminal narrowing, the target sign, and nonspecific lymphadenopathy [108,109]. The case illustrated in Fig.…”

Section: Diagnosis Of Gi Diseasesmentioning

confidence: 99%

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

2008

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Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood. The diagnostic criteria include palpable purpura with at least one other manifestation -- abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. Immune complex deposits result in necrosis of the wall of small- and medium-sized arteries with infiltration of tissue by neutrophils and deposition of nuclear fragments, a process called leukocytoclastic vasculitis (LCV). It is often associated with infections, medications, or tumors. It may coexist with or mimic Crohn's disease. Periumbilical and epigastric pain worsens with meals, from bowel angina. Bleeding is usually occult or, less commonly, associated with melena. Intussusception, the most common surgical complication, is usually ileo-ileo or ileo-colic. Perforations, usually ileal, may occur spontaneously or be associated with intussusception. Ultrasound, recommended as the first diagnostic test, and CT scans may show intussusception and asymmetric bowel wall thickening mainly involving the jejunum and ileum. There are a range of endoscopic findings including gastritis, duodenitis, ulceration, and purpura, with the second portion of the duodenum characteristically being involved more than the bulb. Intestinal biopsies show IgA deposition and LCV in the submucosal vessels. Superficial biopsies may show inflammation, ulceration, edema, hemorrhage, and vascular congestion, presumably due to vasculitis-induced mucosal ischemia. The efficacy of corticosteroids in preventing severe complications or relapses is controversial. The majority of patients, however, improve spontaneously.

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Section: Diagnosis Of Gi Diseasesmentioning

confidence: 99%

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

2008

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“…As in this case, gastrointestinal disease can precede the skin rash (16,18). The most common abdominal symptom is colicky pain, which may be associated with diarrhea, nausea, or vomiting (7,18,19).…”

Section: Discussionmentioning

confidence: 83%

“…The most common abdominal symptom is colicky pain, which may be associated with diarrhea, nausea, or vomiting (7,18,19). Melena is more common in adults than children (5).…”

Section: Discussionmentioning

confidence: 99%

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Case 127: Henoch-Schonlein Purpura

Johnson

Horton²,

Fishman³

2007

Radiology

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HistoryA 37-year-old man presented to his physician with sharp and continuous upper abdominal pain. Upper endoscopy was performed for evaluation and revealed Helicobacter pylori-negative gastritis. Treatment with a proton pump inhibitor failed to alleviate his symptoms. The patient subsequently developed diarrhea and dark stools, followed by a petechial rash that involved his lower extremities. At this point, he was admitted to an outside hospital for evaluation. Colonoscopy and repeat endoscopy revealed nothing that could account for his symptoms. After an observation period, he was discharged. The patient's abdominal pain persisted and worsened. In addition, he felt feverish and developed joint pain, which was most severe in his knees and wrists. Three weeks after the initial episode, he was readmitted to the hospital with intractable abdominal pain and new onset of vomiting. At admission, a petechial rash with regions of purpura was noted on his thighs and calves. A similar rash with a maculopapular appearance was apparent on his upper extremities. Laboratory tests revealed an elevated erthrocyte sedimentation rate and a minimally elevated platelet count. Antinuclear antibody test results were negative. Intravenous contrast material-enhanced multidetector computed tomography (CT) of the abdomen and pelvis was performed the next day, with 120 mL of iohexol (Omnipque 350; GE Healthcare, Princeton, NJ) infused at a rate of 3 mL/sec.

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“…5,11,12,14,22,[24][25][26][27][28][29][30][31] Radiologic evidence of bowel wall thickening and mesenteric edema and the endoscopic abnormalities of erosive gastritis and hyperemic duodenitis associated with this condition have been described. [27][28][29]32 Focusing on the more unusual colonic involvement of adult-type LCV associated with HSP, a MEDLINE search revealed 11 bibliographic references in which the colon is reported to be involved by the vasculitic process: specifically, four patients with massive colo- rectal bleeding, 10,13 two with acute abdomen caused by right colon necrosis, 33 one with large bowel perforation, 25 two with punctuate erythematous lesions in the colon plus occult heme-positive stool, 2 one case of associated clarithromycin use, 34 and seven patients with endoscopic findings of mucosal petechiae and submucosal bleeding. 31,[35][36][37][38] In addition, LCV not associated with HSP leading to overt clinical signs of bowel involvement is reported in two cases.…”

Section: Gastrointestinal (Gi) Involvement In Patients Withmentioning

confidence: 99%

Isolated Colonic Leukocytoclastic Vasculitis Causing Segmental Megacolon: Report of a Rare Case

Vlahos¹,

Theodoropoulos²,

Lazaris

et al. 2005

Diseases of the Colon &Amp; Rectum

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We report the case of a 44-year-old white man who presented with progressively worsening crampy abdominal pain and distention. Deterioration of his clinical picture along with leukocytosis and radiographic evidence of severe colonic dilation rendered exploratory laparotomy necessary. Greatly distended and inflamed transverse and descending colon were evident and an extended left colectomy was performed. Characteristic changes of leukocytoclastic vasculitis in the serosal and muscular layers of the resected colon were demonstrated at histopathologic examination. Systemic leukocytoclastic vasculitis, usually coexisting with Henoch-Schonlein purpura, commonly affects the small bowel with clinical evidence of ischemia or bleeding. Colon involvement is infrequently reported in the context of systemic disease. Isolated colonic leukocytoclastic vasculitis without extraintestinal manifestations is rare. A previously unreported case of localized leukocytoclastic vasculitis of the left colon resulting in the impressive presentation of megacolon, without the presence of any precipitating factor or associated systemic disease is presented here, with an overview of the related literature.

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CT demonstration of gastrointestinal involvement in Henoch-Schonlein syndrome

Cited by 24 publications

References 2 publications

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

Case 127: Henoch-Schonlein Purpura

Isolated Colonic Leukocytoclastic Vasculitis Causing Segmental Megacolon: Report of a Rare Case

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