Rashmi Bawa, MD, Praise Matemavi, MD, Charles V Coren, MD
NewYork Hospital Queens, Flushing , NY
Intussusception is a known complication of Henoch-Schonlein purpura (HSP), the most common systemic small-vessel vasculitis in childhood. HSP is characterized by purpuric rash principally on the buttocks and lower extremities, arthritis, nephritis and gastrointestinal symptoms. It is postulated that intussusception is due to submucosal edema and hemorrhage of the small bowel, which becomes a lead point. There is an even distribution between ileoileal and ileocolic intussusception in HSP rather than in idiopathic intussusceptions where they tend to be mostly ileocolic.
We report a 5-year-old boy with HSP and clinical manifestations of HSP including purpuric rash bilateral lower extremities over a period of 3 weeks prior to presentation, being treated with oral steroids. Patient presented with intermittent crampy abdominal pain for 24 hours. There was no history of nausea, vomiting, bloody diarrhea or fevers. Abdominal X-ray showed dilated loops of small bowel with air fluid levels necessitating CT scan of abdomen and pelvis for further evaluation. CT abdomen and pelvis with contrast revealed thickening of several loops of mid and distal ileum with evidence of ileoileal intussusceptions. The patient was taken to the operating room immediately and underwent a laparoscopic reduction of intussusception without bowel resection. Patient did very well postoperatively and discharged home on forth postoperative day on regular diet.
Most of the patients with HSP who have GI symptoms are treated nonoperatively; however the rate of laparotomy due to life threatening complications ranges from 5 to 10%; most frequently due to intussusception. Crampy abdominal pain that progresses to obstruction may warrant suspicion of intussception in patients with HSP.
The literature supports nonoperative treatment for HSP patients with suspected intussusception, regardless of diagnostic uncertainty. Contrast enema reduction is indicated for ileoileal intussception where as surgical exploration is indicated for ileoileal intussception.
Laparoscopic exploration is a viable option for patient with HSP complicated by intussusception. Laparscopic approach can decrease postoperative morbidity and hospital stay.
Session: Poster Presentation
Program Number: P512