Surgical Evaluation of Henoch-Schönlein Purpura Experience With 110 Children

Abstract

Henoch-Schönlein purpura is a disorder of unknown origin that is probably related to an autoimmune phenomenon. This report concerns 110 children (mean age, 6.2 years; range, 6 months to 14 years) with Henoch-Schönlein purpura. Seventy-two (65%) had abdominal pain associated with nausea and vomiting, bloody stool, and upper gastrointestinal bleeding. Sixty patients with abdominal pain were evaluated and treated conservatively. However, 12 patients underwent laparotomy. Six underwent unnecessary appendectomy for wrongly diagnosed appendicitis. Bowel resection was performed in one patient for an obstructive ileal lesion. Six additional patients had intussusception; surgery was required in three, while barium enema reduction was successfully accomplished in three others. Massive gastric hemorrhage required ligation, vagotomy, and pyloroplasty in two instances. One child with severe scrotal pain, hemorrhage, and swelling underwent unnecessary scrotal exploration. Four additional patients with similar symptoms avoided operation after a testicular scintiscan demonstrated good blood flow. A high index of suspicion and early diagnosis of Henoch-Schönlein purpura based on clinical, roentgenographic, and laboratory findings may avoid unnecessary operations in most cases. However, life-threatening complications (hemorrhage, obstruction, and intussusception) may occur and require operative intervention. All of the patients survived.

Henoch-Schönlein purpura

“…One of the cases underwent colonoscopy, and intussusception was reduced by colonoscopic insufflation [13] . In contrast, intestinal ischemia, perforation, hemorrhage, fistulas, pancreatitis, and appendicitis are rare [9,14] . However, Zhang et al [10] in their assessment of adult patients with gastrointestinal manifestations of HSP showed that the first symptoms may appear as "acute abdomen" without lesions, and that gastroscopy and colonoscopy may be helpful in early diagnosis.…”

A rapid response to steroid therapy in acute scrotum: A case of Henoch-Schönlein purpura

“…Bu yüzden akut skrotum yapan sebeplerden HSP'nin varlığını bilmek önemlidir. Önceki serilere bakıldığında HSP'ye bağlı akut skrotum gelişen olgularda cerrahi eksplorasyon uygulandığı görülmektedir (2,3,6) . Soreide ve ark.…”

Wireless Capsule Endoscopy in Pediatric Gastrointestinal Diseases

“…As an optional application, CE can be applied to evaluate the management of gastrointestinal diseases such as Henoch-Schonlein purpura (HSP) (Preud'Homme DL, 2006) and GVHD (Silbermintz, 2006;Yakoub-Agha I, 2004). In HSP, sastrointestinal bleeding occurs in ~50% of children, and massive bleeding may occur (Katz, 1991). A previous report demonstrated that CE contributed to identify the extent of the small intestinal involvement of HSP and confirmed the efficacy of cyclophosphamide therapy in improving the gastrointestinal lesions (Preud 'Homme DL, 2006).…”