Jejunojejunum intussusception as the single initial manifestation of Henoch-Schönlein purpura in a teenager

Lim, Cherng-Jyr; Chen, Jiann-Hwa; Chen, Wei-Lung; Shen, Ying-Sheng; Huang, Chien‐Cheng

doi:10.1016/j.ajem.2011.12.003

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…X-ray was not effective in cases where occult blood stool tests and biopsy results were negative. The results of the present study were consistent with a previous retrospective study (13) and a previous case report (3). The As Low As Reasonably Possible principle is required to maintain in the CT of children to avoid the risk of cancer (12), which is difficult to manage in children (16).…”

Section: Discussionsupporting

confidence: 92%

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

Ge¹,

Liu

2020

Exp Ther Med

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Imaging modalities are not included in The European League Against Rheumatism, The Pediatric Rheumatology International Trials Organization and The Pediatric Rheumatology European Society 2010 criteria for the evaluation of abdominal purpura. The objective of the present study was to compare diagnostic parameters of ultrasound, X-ray and computed tomography (CT) for diagnosis of abdominal purpura considering the American College of Rheumatology (ACR) criteria as 'reference standard' in children with acute abdominal pain. Medical records of 215 children with acute abdominal pain were reviewed. Data regarding demographics and clinical characteristics, laboratory tests, X-ray, ultrasound findings, and computed tomographic images were collected and analyzed. Decision curve analysis was used for evaluation of the beneficial score for each diagnostic modality. Among diagnostic modalities, CT had the highest sensitivity (0.939); however, ultrasound findings had the highest accuracy (0.861) for diagnosis of abdominal purpura. Unlike X-ray and laboratory tests, ultrasound and CT were successful at detecting abdominal purpura when children had only colicky pain and were aged <20 years; however, occult blood stool test and granulocytes in the walls of small venules and arterioles (biopsy results) were negative. With respect to the ACR criteria, there were seven and three inconclusive results for ultrasound and CT, respectively. Abdominal ultrasound is an easy, non-invasive and safe method for the detection of abdominal purpura in children.

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Section: Discussionsupporting

confidence: 92%

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

Ge¹,

Liu

2020

Exp Ther Med

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“…8,9 Abdominal manifestation and GI involvement are common in children and adults. [15][16][17] In this case, ileocolic intussusception as the single initial manifestation in an adult patient has never been reported. 7,10 Intussusception is the most common GI complication of HSP during childhood.…”

Section: Discussionmentioning

confidence: 80%

Henoch-Schönlein Purpura With Intussusception in an Adult

Huang

Fan

Chen

et al. 2012

The American Journal of the Medical Sciences

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“…The most likely causes of the ileus in a patient with Henoch-Schönlein purpura and acute colicky pain are intussusception, intestinal obstruction (owing to intramural hemorrhages), and intestinal perforation. 1 An abdominal ultrasound examination showed a "target sign" (outer hypoechoic ring from the edematous walls of the intussuscipiens around an echodense center of the intussuceptum; Figure B), confirming ileocecal intussusception while no subdiaphragmatic free gas was seen on the abdominal radiograph. A surgeon was consulted, but on laparoscopy intussusception could not be detected.…”

mentioning

confidence: 96%

“…2,3 Intussusception in children with HSP is rare but has been described. 1,2 Intussusception usually presents as abdominal pain, nausea or vomiting, bloody stool, and (transient) ileus. 1 Corticosteroids reduce the mean time to resolution of abdominal symptoms and decrease the risk of developing persistent renal disease in children with HSP.…”

mentioning

confidence: 99%

“…1,2 Intussusception usually presents as abdominal pain, nausea or vomiting, bloody stool, and (transient) ileus. 1 Corticosteroids reduce the mean time to resolution of abdominal symptoms and decrease the risk of developing persistent renal disease in children with HSP. 2 Outcome in cases of intussusception is variable, ranging from spontaneous resolution to intestinal infarction requiring resection.…”

mentioning

confidence: 99%

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A Case Report of a Child With Purpura, Severe Abdominal Pain, and Hematochezia

2017

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Question: A 5-year old Caucasian boy presented with sudden onset of diffuse purpuric and petechial skin lesions without fever at the pediatric department. The following days he developed diffuse abdominal pain with bloody stools (4-6 times a day). He also complained of scrotal pain and joint pain (knee, ankles). His previous medical history was unrevealing. Family history was negative for autoimmune or gastrointestinal diseases. He had not taken medication besides paracetamol. Clinical examination revealed an alert but tachycardic boy with a blood pressure of 130/90 mm Hg. Pharyngeal aphthous lesions with slight facial edema and edema of the hands were noticed. Diffuse purpuric and petechial lesions of the face, arms, legs, buttocks, and abdomen were present. Auscultation of lungs and heart was normal. The abdomen was diffusely painful on palpation without rebound tenderness or guarding and without signs of organ (liver, spleen) enlargement. An enlarged and painful left scrotum was seen. His laboratory results showed: hemoglobin of 10.8 g/dL (reference, 11-14); leukocytes of 23.8 Â 10 3 /mL (reference, 6-14); platelets of 693 Â 10 3 /mL (reference,150-450); C-reactive protein of 57.5 mg/L (reference, <0.5); blood urea nitrogen of 24 mg/dL (reference, 12-42); serum creatinine of 0.29 mg/dL (reference, 0.32-0.59); total protein of 49 g/L (reference, 62-78); and albumin of 25 g/L (reference, 35-52). Electrolytes, coagulation times, liver enzymes, and lipase were within normal range but urinalysis showed nephrotic range proteinuria (3.6 g/L; reference, 0-0.2)), hematuria (4000/mL; reference, 0-25), and leukocuyturia (370/mL; reference, 0-25). Blood and urine cultures remained negative. Abdominal ultrasound showed no abnormalities of liver, kidneys, or spleen and with adequate peristalsis of the intestines. Ultrasound of the scrotum showed diffuse enlargement and hypervascularization of left epididymis consistent with epididymitis. Hematochezia persisted and 2 days after admission he suddenly developed severe colicky abdominal pain with reduced peristalsis. An abdominal radiograph was taken (Figure A) revealing an ileus. What is the most likely underlying diagnosis and which complication could the acute colicky abdominal pain with radiographic confirmation of an ileus represent? How would you explain the hematochezia? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Jejunojejunum intussusception as the single initial manifestation of Henoch-Schönlein purpura in a teenager

Cited by 10 publications

References 6 publications

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

Henoch-Schönlein Purpura With Intussusception in an Adult

A Case Report of a Child With Purpura, Severe Abdominal Pain, and Hematochezia

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