Duodenal findings on ultrasound in children with Schonlein-Henoch purpura and gastrointestinal symptoms.

Abdominal ultrasonic examination was performed in 14 patients with Schonlein-Henoch purpura (SHP). Thickening of the duodenal wall was observed in nine (82%) of the 11 with such gastrointestinal (GI) symptoms as severe abdominal pain or bleeding. The thickened duodenal wall showed a high echogenicity. Enlargement of the duodenal lumen was seen in seven (64%) patients with GI symptoms. These findings had been observed in four patients before SHP was diagnosed on the basis of the peculiar skin lesions. In three cases of SHP without GI symptoms, those changes were absent. Four cases of ulcerative colitis, three of bacterial enterocolitis (two Yersinia and one Klebsiella), and five without SHP and any GI problems did not exhibit such duodenal abnormalities. On subsequent endoscopic study, mucosal edema and multiple hemorrhagic erosions were seen, especially at the second portion of the duodenum in two cases of SHP. Biopsy specimens from the duodenum of those cases showed leukocytoclastic vasculitis, suggested by the ultrasound (US) findings. It is important to consider the duodenal changes carefully when US is performed in patients with severe GI symptoms of unknown origin. The characteristic duodenal findings described suggest the differential diagnosis of SHP, which usually requires no surgical intervention.