Gastrointestinal sonographic findings in Henoch-Schonlein purpura

The objective of this study was to document the spectrum of sonographic findings in the gastrointestinal tract of children with abdominal pain due to Henoch-Schonlein purpura. The abdominal ultrasound images of 13 consecutive patients with Henoch-Schonlein purpura were retrospectively analyzed, with special attention to the following findings: thickened bowel wall; dilated, obstructed intestinal loops; free peritoneal fluid; intussusception; and miscellaneous findings. All 13 patients demonstrated one or more segments of thickened intestine, usually in the small intestine. Circumferential, echogenic thickening of the mucosa and submucosa was the most common finding (10 of 13 patients). In one patient, mucosal thickening was asymmetric, and two patients demonstrated findings which at first suggested intussusception but later were found to represent intramural hematomas. Free peritoneal fluid was seen in seven patients (53.8%). Ultrasound is sensitive, but not specific, in detecting gastrointestinal manifestations of Henoch-Schonlein purpura. The most common finding is segmental, circumferential, echogenic thickening of the intestinal wall. Free peritoneal fluid also is a relatively common finding, and, in addition, intramural hematoma can be a problem because its configuration can be mistaken for intussusception, a well-known complication of this disease.