All issues > Volume 46(6); 2003

Original Article

J Korean Pediatr Soc. 2003;46(6):576-584. Published online June 15, 2003.

Henoch-Scholein Purpura Presenting with Acute Abdominal Pain Preceding Skin Rash : Review of 23 Cases

Ju Young JY Chang¹, Yong Joo YJ Kim², Kyo Sun KS Kim³, Hee-Ju HJ Kim¹, Jeong Kee JK Seo¹

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
²Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
³Department of Pediatrics, College of Medicine, Konkuk University, Seoul, Korea

Correspondence Jeong Kee JK Seo ,Email: jkseo@plaza.snu.ac.kr

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 gastrointestinal 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.

Keywords :Henoch Scholein purpura, Duodenitis, Endoscopy, Ultrasonogram, Acute abdominal pain