Surgical complications of Henoch-Schönlein purpura in children

Henoch-Schönlein purpura is the systemic pathology that affected the small vessels of the skin, gastrointestinal tract, kidneys, and joints. Typical clinical manifestation of Henoch-Schönlein purpura include palpable purpura, abdominal pain syndrome, arthralgia, renal involvement, and, in some children, externa genitalia involvement. The aim of this study was to present the own experience in the management of three children with the surgical complications of Henoch-Schönlein purpura. The own experience includes three children with Henoch-Schönlein purpura, particularly two children with ileum intussusception (both of 3 years old) and one patient of 4 years old with the syndrome “acute scrotum”. Gastrointestinal involvement may appear in most of patients with Henoch-Schönlein purpura and intussusception is the most common complication, which require the urgent treatment. Appearance of typical palpable purpura followed the abdominal pain syndrome and ultrasonography is the main method of diagnostic in this group of patients. Ileum and ileocolic are the common types of intussusception in children with Henoch-Schönlein purpura. The main method of treatment in case of ileum intussusception is surgical reduction, while in case of ileocolic intussusception non-surgical reduction can be applied. Besides the typical manifestation of Henoch-Schönlein purpura, in some children could be the scrotal involvement, which developing after appearance of palpable purpura, and rare caused by inflammation or torsion of testis or hydatid. It is believed that patients with Henoch-Schönlein purpura and scrotal involvement have more severe clinical course when compared with patients with abdominal manifestation, which agreed with our observation. Conclusions. In children older than one year, with the abdominal pain, with or without bloody stools, and ultrasonographic signs of intussusception, it is necessary consider about possibility the presence of Henoch-Schönlein purpura in these patients. In children with Henoch-Schönlein purpura despite the corticosteroids’ treatment, could be developed the syndrome of “acute scrotum”, which required emergent surgery. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.