A Case of Laparotomy in Adult Henoch-Schoenlein Purpura with Chief Complaint of Abdominal Symptoms

Kenji Shimizu, Akihito Nakanishi, Takashi Hayashi, Bunpei Sato and Masae Tsuji

Department of Surgery, Koseikai Takeda Hospital

We report a case of laparotomy in adult Henoch-Schoenlein purpura. A 58-year-old man admitted for severe abdominal pain was found on physical examination to have tenderness, rebound tenderness, and muscle defense in the upper left quadrant of the abdomen. Abdominal computed tomography showed marked wall thickness at the duodenum and upper jejunum. We conducted emergency laparotomy on suspicion of ileus or necrosis of the small intestine. Operative findings involved sporadic marked redness and swelling at the jejunum. We suspected unspecific inflammatory bowel disease and completed surgery without resecting the lesion. Purpura on the right thigh and proteinuria were pointed out postoperatively, and gastrointestinal endoscopy showed edematous, hemorrhagic mucosa at the duodenum. Histological examination of the skin and duodenum biopsy disclosed leucocytoclastic vasculitis and small-vessel vasculitis. We diagnosed this case as adult Henoch-Schoenlein purpura and treated him with predonisolone. Abdominal symptoms, purpura, and proteinuria subsided within 1 month after treatment.

Key words
abdominal symptom, purpura, small-vessel vasculitis

Reprint requests
Kenji Shimizu Departemnt of Surgery, Koseikai Takeda Hospital
Shiokojitouri Shimogyo, Kyoto, 600-8558 JAPAN

Accepted
September 24, 2003

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