Henoch-Scholein Purpura Presenting with Acute Abdominal Pain Preceding Skin Rash: Review of 23 Cases .
- Author:
Ju Young CHANG
;
Yong Joo KIM
;
Kyo Sun KIM
;
Hee Ju KIM
;
Jeong Kee SEO
- Publication Type:Original Article
- Keywords:
Henoch Scholein purpura;
Duodenitis;
Endoscopy;
Ultrasonogram;
Acute abdominal pain
- MeSH:
Abdomen, Acute;
Abdominal Pain*;
Diagnosis;
Duodenitis;
Duodenum;
Early Diagnosis;
Endoscopy;
Exanthema*;
Gastrointestinal Hemorrhage;
Hemorrhage;
Nephritis;
Purpura*;
Recurrence;
Sigmoidoscopy;
Skin*;
Ulcer;
Ultrasonography
- From:Journal of the Korean Pediatric Society
2003;46(6):576-584
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash. METHODS: The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed. RESULTS: The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year. CONCLUSION: The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.
