Abdominal pain is a frequent symptom in the child with Henoch-Schonlein purpura and raises the suspicion of intussusception or perforation. One hundred and fifty two children with a diagnosis of Henoch-Schonlein purpura over 11 years were reviewed. Of these 60 had abdominal pain, 19 gastrointestinal bleeding, and nine were suspected intussusception. Intussusception was confirmed in two of these cases with ultrasonography.Ultrasound is an important tool in the early diagnosis of intussusception complicating Henoch-Schonlein purpura. Where the intussusception appears loose an expectant policy, with careful monitoring, may allow spontaneous reduction. It may also be used in monitoring patients for postoperative recurrence of intussusception, mural haematoma, and uncomplicated intestinal vasculitis with oedema.Abdominal pain and gastrointestinal bleeding are common manifestations of HenochSchonlein purpura, resulting from vasculitis, intestinal oedema, mural haemorrhage, intussusception, necrosis, and perforation.1-3Intussusception is an uncommon complication, yet its diagnosis is made more difficult in this situation.4 5 Not only is its clinical presentation less distinctive, especially when the child already had abdominal symptoms and signs, but definitive diagnosis and treatment by barium or air enema is made more hazardous in view of the underlying intestinal vasculitis and may not be accessible by the enema as it will usually be in the small intestine.6Ultrasonography was useful in the diagnosis of intussusception in two recent cases. To try to establish the extent of the problem it was decided to review the surgical experience in all patients admitted to the hospital with HenochSchonlein purpura over an 11 year period.19 had gastrointestinal bleeding, and nine were suspected of having intussusception. Intussusception was excluded in most of the cases either by clinical examination, plain film of the abdomen, and more recently by ultrasound in five cases. It was confirmed in two cases by ultrasound, which constituted 1-3% of the patients analysed, and these are reported below. CASE 1A 5 year old boy was admitted in 1989 with a two day history of swelling of the feet and wrists, a purpuric rash on the ankles, scrotal erythema, vomiting, and intermittent abdominal pain. Urine analysis revealed proteinuria. A clinical diagnosis of Henoch-Schonlein purpura was made. His symptoms settled and he was discharged after six days.One week later he was readmitted to the hospital with acute severe abdominal pain, tenderness all over the abdomen but no mass was palpable. A plain film of his abdomen was suggestive of intussusception, which was confirmed by ultrasound (fig 1). Hydrostatic or barometric reduction was not attempted in view of the underlying vasculitis. At laparotomy an ileoileal intussusception was identified and reduced manually with some difficulty. Though the bowel was congested looking it was viable with no perforation, and an appendicectomy was done.Initially he had an uncomplicated recovery,

Benign tumors of the small bowel are rare. They present with many different manifestations depending on the size and location, and also cause a variety of symptoms that are often nonspecific. These include abdominal pain, dyspepsia, nausea, vomiting, and gastrointestinal bleeding that may be melena or hematemesis. Most of the time patients are asymptomatic and the lesions are discovered as an incidental finding. When bleeding occurs, and it may be severe in certain situations, the patient may develop signs of anemia, such as dyspnea, fatigue, and even high-output cardiac failure. The authors present a patient who was evaluated for melena and who was found to have a duodenal polyp that proved to be a Brunner's gland adenoma on pathology.