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Jejunal haemorrhage in Henoch-Schönlein syndrome
  1. K Nistala1,
  2. W Hyer1,
  3. S Halligan2
  1. 1Northwick Park Hospital, London, UK; k.nistala{at}ich.ucl.ac.uk
  2. 2St Marks Hospital, Watford Road, Harrow, UK

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A 14 year old boy presented to the paediatric department with a two week history of severe recurrent colicky abdominal pain, anorexia, and weight loss. On examination he had localised tenderness in his epigastrium, no guarding, normal bowel sounds, and normal urine dipstick. A petechial rash was noted on extensor surfaces of the distal portions of his upper and lower extremities. His pain deteriorated on day 5 of admission despite a morphine infusion. A computed tomographic (CT) scan of the abdomen and pelvis with contrast showed a doughnut shaped mass of high attenuation (see arrows in fig). This represents an axial section of jejunum with gross mural thickening consistent with intramural haemorrhage. A diagnosis was made of Henoch-Schönlein purpura (HSP) complicated by jejunal vasculitis. The patient was treated conservatively and went on to make a full recovery.

CT is an excellent means of assessing the gastrointestinal complications of HSP as it is rapid and non-invasive. Other findings that CT can show include dilated intestinal loops, regional lymphadenopathy, and free air in the case of intestinal perforation.1

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