Choong C K, Beasley S W
Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
J Paediatr Child Health. 1998 Oct;34(5):405-9. doi: 10.1046/j.1440-1754.1998.00263.x.
Gastrointestinal involvement occurs in approximately two thirds of children with Henoch-Schönlein Purpura (HSP) and usually is manifested by abdominal pain. Abdominal symptoms precede the typical purpuric rash of HSP in 14-36%; the symptoms may mimic an acute surgical abdomen and result in unnecessary laparotomy. Major complications of abdominal involvement develop in 4.6% (range 1.3-13.6%), of which intussusception is by far the most common. The intussusceptum is confined to the small bowel in 58%; its frequent inaccessibility to demonstration by contrast enema means that ultrasonography is the investigation of choice. Ultrasonography complements serial clinical assessment, clarifies the nature of the gastrointestinal involvement and reduces the likelihood of unnecessary surgery. Bowel ischaemia and infarction, intestinal perforation, fistula formation, late ileal stricture, acute appendicitis, massive upper gastrointestinal haemorrhage, pancreatitis, hydrops of the gallbladder and pseudomembranous colitis are seen infrequently. Earlier diagnosis and prompt treatment of intra-abdominal complications has reduced the mortality from 40% to almost zero.
约三分之二的过敏性紫癜（HSP）患儿会出现胃肠道受累，通常表现为腹痛。14% - 36%的患儿腹部症状先于典型的紫癜性皮疹出现；这些症状可能类似急腹症，导致不必要的剖腹手术。腹部受累的主要并发症发生率为4.6%（范围1.3% - 13.6%），其中肠套叠是最常见的。58%的肠套叠发生在小肠；由于对比灌肠常难以显示，超声检查成为首选的检查方法。超声检查辅助连续的临床评估，明确胃肠道受累的性质，减少不必要手术的可能性。肠道缺血和梗死、肠穿孔、瘘管形成、晚期回肠狭窄、急性阑尾炎、大量上消化道出血、胰腺炎、胆囊积液和假膜性结肠炎较少见。对腹腔内并发症的早期诊断和及时治疗已使死亡率从40%降至几乎为零。
