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,

Background Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification. Methods The piANs were classified into type I: aneurysm really arises from perforating artery, type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb), and type III: fusiform aneurysm involves perforating artery. Stent protection technology of PPT was applied in type I and III aneurysms, and coil-basket protection technology in type II aneurysms. An immediate outcome of aneurysmal obliteration after treatment was evaluated (satisfactory obliteration: the saccular aneurysm body is densely embolized (I), leaving a gap in the neck (IIa) or dome (IIb) where the perforating artery arising; fusiform aneurysm is repaired and has a smooth inner wall), and successful perforating artery preservation was defined as keeping the good antegrade flow of those perforators on postoperative angiography. The periprocedural complication was closely monitored, and clinical and angiographic follow-ups were performed. Results Six consecutive piANs (2 ruptured and 4 unruptured; 1 type I, 2 type IIa, 2 type IIb, and 1 type III) in 6 patients (aged from 43 to 66 years; 3 males) underwent endovascular therapy between November 2017 and July 2019. The immediate angiography after treatment showed 6 aneurysms obtained satisfactory obliteration, and all of their perforating arteries were successfully preserved. During clinical follow-up of 13–50 months, no ischemic or hemorrhagic event of the brain occurred in the 6 patients, but has one who developed ischemic event in the territory of involving perforators 4 h after operation and completely resolved within 24 h. Follow-up angiography at 3 to 10M showed patency of the parent artery and perforating arteries of treated aneurysms, with no aneurysmal recurrence. Conclusions Our perforator preservation technologies on the basis of the new neuro-interventional classification seem feasible, safe, and effective in protecting involved perforators while occluding aneurysm.

Background and Purpose Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification.Methods The piANs were classified into Type I: aneurysm really arises from perforating artery; Type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb); Type III: fusiform aneurysm involves perforating artery. Stent protection technology of PPT was applied in Type I and III aneurysms, and coil-basket protection technology in Type II aneurysms. Immediate outcome of aneurysmal obliteration after treatment was evaluated (Satisfactory Obliteration: The saccular aneurysm body is densely embolized (I), leaving a gap in the neck (IIa) or dome (IIb) where the perforating artery arising; fusiform aneurysm is repaired and has a smooth inner wall), and successful perforating artery preservation was defined as keeping good antegrade flow of those perforators on postoperative angiography. Periprocedural complication was closely monitored, and clinical and angiographic follow-up were performed.Results Six consecutive piANs (2 ruptured and 4 unruptured; 1 Type I, 2 Type IIa, 2 Type IIb and 1 Type III) in 6 patients (aged from 43 to 66 years; 3 males) underwent endovascular therapy between November 2017 and July 2019. The immediately angiography after treatment showed 6 aneurysms obtained satisfactory obliteration; and all of their perforating arteries were successfully preserved. During clinical follow-up of 13–50 months), no ischemic or hemorrhagic event of brain occurred in the 6 patients, but one who developed ischemic event in the territory of involving perforators 4 h after operation, and completely resolved within 24 h. Follow-up angiography at 3M to 10M showed patency of the parent artery and perforating arteries of treated aneurysms, with no aneurysmal recurrence.Conclusions Our perforator preservation technologies on basis of the new neuro-interventional classification seems feasible, safe and effective in protecting involved perforators while occluding aneurysm.