Korean J Gastroenterol.  2017 Jun;69(6):372-376. 10.4166/kjg.2017.69.6.372.

Henoch-Schönlein Purpura Presenting as Intussusception

• Kim KY

• KMID: 2384366
• DOI: http://doi.org/10.4166/kjg.2017.69.6.372

Abstract

Henoch-Schönlein purpura (HSP) is systemic vasculitis disease with various clinical manifestations. Gastrointestinal symptoms in patients with HSP are usually common, with an incidence rate of 62-90%. Most of these gastrointestinal symptoms occur after typical skin purpura, which is a very important clinical evidence for making a diagnosis of HSP. It is difficult to diagnose HSP without skin rash. About 25% of patients may experience gastrointestinal symptoms as their first symptoms. Herein, we report a case of ileo-colic intussusception associated with HSP in a 5-years-old girl presented with diffuse abdominal distension. Our patient did present any symptoms of HSP, such as purpura, arthralgia or arthritis, before surgery.

Keyword

Henoch-Schonlein purpura; Ileus; Intussusception

MeSH Terms

Arthralgia
Arthritis
Diagnosis
Exanthema
Female
Humans
Ileus
Incidence
Intussusception*
Purpura*
Purpura, Schoenlein-Henoch
Skin
Systemic Vasculitis

Figure

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  Fig. 1 Abominopelvic X-ray findings. (A) Supine simple abdomen showing dilated loops of the small intestine and bowel edema. (B) Erect simple abdomen showing multiple air-fluid levels with a step ladder sign.

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  Fig. 2 Abdominopelvic computed tomography finding. Coronary view showing severe dilated small intestine and ileo-colic intussusception with target sign (arrow).

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  Fig. 3 Operative findings. (A) Before manual reduction. The ileocolic type intussusception is observed (arrow). (B) After manual reduction. Severe hemorrhagic infarction in the small intestine is observed (arrow).

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  Fig. 4 Patient's skin lesion. Various forms of skin purpura are observed at (A) the arm, and (B) the knee.

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  Fig. 5 Microscopic findings of the ileum. Inflammation is observed around the submucosal vessels (circle) (H&E, ×200).

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