Surgical evaluation of Henoch-Schonlein purpura. Experience with 110 children
S. Katz, M. Borst, I. Seekri and J. L. Grosfeld
Department of Surgery, Indiana University School of Medicine, Indianapolis.
Henoch-Schonlein purpura is a disorder of unknown origin that is probably
related to an autoimmune phenomenon. This report concerns 110 children
(mean age, 6.2 years; range, 6 months to 14 years) with Henoch-Schonlein
purpura. Seventy-two (65%) had abdominal pain associated with nausea and
vomiting, bloody stool, and upper gastrointestinal bleeding. Sixty patients
with abdominal pain were evaluated and treated conservatively. However, 12
patients underwent laparotomy. Six underwent unnecessary appendectomy for
wrongly diagnosed appendicitis. Bowel resection was performed in one
patient for an obstructive ileal lesion. Six additional patients had
intussusception; surgery was required in three, while barium enema
reduction was successfully accomplished in three others. Massive gastric
hemorrhage required ligation, vagotomy, and pyloroplasty in two instances.
One child with severe scrotal pain, hemorrhage, and swelling underwent
unnecessary scrotal exploration. Four additional patients with similar
symptoms avoided operation after a testicular scintiscan demonstrated good
blood flow. A high index of suspicion and early diagnosis of
Henoch-Schonlein purpura based on clinical, roentgenographic, and
laboratory findings may avoid unnecessary operations in most cases.
However, life-threatening complications (hemorrhage, obstruction, and
intussusception) may occur and require operative intervention. All of the
patients survived.
