=Abstract=
:±O}.9-1Jrl-~lAl9-1 Henoch-Schonlein ~}l{!-~
Henoch-Schonlein Purpura in Pediatric Surgery
Dae Yeon Kim, M.D., Seong Chul Kim, M.D., In Koo Kim, M.D.
Division of Pediatric Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
Seoul, Korea
Henoch-Schonlein purpura is a systemic vasculitis of unknown
etiologythat is probably related to an
autoimmunephenomenon. Henoch-Schonlein purpura is characterized by a purpuric rash, arthralgia, nephritis, and
gastrointestinalmani- festations. We reviewed 169
childrenhospitalized
with adiagnosis of Henoch- SchOnlein purpura between 1989
and1998. One-hundred thirty-nine
(82.2 %)had gastrointestinal findings including abdominal pain, nausea, vomiting and gas- trointestinal bleeding. Surgical consultations were obtained for ten children,
andlaparotomy was performed in five. Three children suspected of having appendi- citis underwent appendectomy
.None had
appendicitis.One child thought to have been intestinal
strangulationwas found to have hemorrhagic
edemaof the proximal jejunum and of the distal ileum. Another child underwent resection for an hemorrhagic infarct of the distal ileum. A high index of suspicion of this
diseaseentity in the differential diagnosis of
abdominalpain in children can avoid
unnecessary laparotomyin most cases. However, life-threatening gastro- intestinal complications may occur in low percentage of cases. Prompt recognition and adequate radiologic
evaluationof the abdominal manifestation of this
entityis necessary for
early surgicalintervention.
Index Words:
Henoch-Scho-nlein purpura, Pediatric
sur~eryHenoch-SchOnlein A1fr~.g. ~o}ojlAi 7r;;<J ~~
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~oj]Ai u~\1 13.5Correspondence: In Koo Kim, M.D., Division of Pedi- atric Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 PunRl1ap-donR, SonRpa-Ru, Seoul 138-736, Korea
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Fig. 1. Clinical manifestations in 165 cases of Hen- och-Schonle!n purpura.
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Fig. 2. Clinical and laboratory findings in patients with Henoch-Schonlein purpura.
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78.87H%J.(15.4-1767H%J.)01~q.Table 1. Criteria for the Classification of Henoch-Schonlein Purpura5 Criteria
1. Palpable purpura
2. Age";;20 at disease onset 3. Bowel angina
4. Wall granulocytes on biopsy
Definition
Slightly raised "palpable" hemorrhagic skin lesions. not related to thrombocytopenia.
Patient 20 years or younger at onset of first symptoms.
Diffuse abdominal pain. worse after meals. or the diagnosis of bowel ischemia. usually including bloody diarrhea.
Histologic changes showing granulocytes in the walls of arterioles or venules.
* The four criteria identified. two of which are necessary to make the diagnosis.
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Jl, Henoch-Schonlein 7-1 \1% ~5'- {llj- .'@ +oJ]5:. ~:§:}7] w'1l ~01] qj ~ T~~ :7.1:7.]9.1~lj-o] '1:J7-] ~q. Henoch-Schonlein 7-}\1%o1]Al g.Aj 7H*~g ~0]7] ~tHA1-c- 0] ~~9.1 'iJ.AJ 7cl:i!]-9} ~~ g
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~J.~E-5'- i'-9.1 ~..g. 'iJ .AJ'tl-%JJl- ~-¥- 3':%:rrJ-7,:j A} %9.1 llJA}~ 7,:jA}5'- {}~j)}Jl 11~~ ~1i'g tHo]: ~q.1. Stewart M, Savage JM, Bell B, McCord B:
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9. ~
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~ 0] w'1l.'@Henoch-Schbnlein 7-} \1~ loj]. qj ~
91
JJl-~ ~7-] 48(3), 1995
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17. 11 Aj~, 3'::,Aj
%,
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~ 01] qj ~ 'iJ .AJ.3j 2%. ~ o}:i!]- 36(8): 1124- 1131, 1993
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