title: Conservative treatment for small intestinal intussusception associated with Henoch-Schönlein's purpura.
abstract: OBJECTIVE
  Emergency laparotomy is generally considered the appropriate course of action for small bowel intussusception associated with Henoch-Schönlein's purpura (HSP). In this paper, we define a conservative approach after witnessing spontaneous reduction of ileoileal invagination at laparotomy in a patient with HSP who had been on steroid therapy for renal involvement.
  
  
  METHODS
  HSP was diagnosed by the appearance of a purpuric rash without thrombocytopenia. Intussusception was diagnosed by ultrasonography (USG) and plain abdominographs, which showed signs of obstruction, and clinical examination. Barium enema was used to treat ileocolic intussusceptions, and conservative therapy, consisting of nasogastric drainage, steroids, and intravenous fluid administration, was used to treat ileoileal intussusceptions. Emergency laparotomy was performed for the patients unresponsive to therapy within 24 h, those with peritonitis, and those with ileocolic invagination not able to be reduced by barium enema.
  
  
  RESULTS
  Six children with an ileoileal intussusception and one with an ileocecal intussusception were studied. The average age was 6 years old. Apart from the initial patient in whom spontaneous reduction was seen at laparotomy, three others required emergency laparotomy; for ileocolic intussusception unable to be reduced by barium enema in one, for ileoileal invagination with peritonitis on admission in one, and for ileoileal intussusception unresponsive to conservative therapy in one. The other three patients were successfully treated by conservative therapy.
  
  
  CONCLUSIONS
  Conservative therapy is feasible for HSP patients with small bowel intussusception as long as the time of onset is known, an ultrasonographic and X-ray diagnosis is confirmed, emergency operating facilities are available, and an experienced pediatric surgical team follows up the patients.
authors.affiliation: Department of Pediatric Surgery, Gazi Medical Faculty, Gazi University, 46. Sokak 28/3, Bahcelievler, 06510 Ankara, Turkey.
authors.forename: Kaan
authors.initials: K
authors.lastname: Sönmez
authors.forename: Zafer
authors.initials: Z
authors.lastname: Turkyilmaz
authors.forename: Billur
authors.initials: B
authors.lastname: Demirogullari
authors.forename: Ramazan
authors.initials: R
authors.lastname: Karabulut
authors.forename: Yusuf Z
authors.initials: YZ
authors.lastname: Aral
authors.forename: Oznur
authors.initials: O
authors.lastname: Konuş
authors.forename: A Can
authors.initials: AC
authors.lastname: Başaklar
authors.forename: Nuri
authors.initials: N
authors.lastname: Kale
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D007077:Ileal Diseases / Q000209:etiology / Q000628:therapy*; D007443:Intussusception / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male