title: [Abdominal symptoms necessitating surgical intervention as the initial presentation of Henoch-Schönlein purpura in children - case reports].
abstract: Henoch-Schönlein purpura (HSP) is the most common pediatric autoimmune vasculitis. Gastrointestinal symptoms of HSP including abdominal pain, diarrhea, and vomiting may precede skin changes by several days. We present diagnostic challenges in two adolescents with HSP and severe abdominal symptoms necessitating surgical intervention before the development of skin changes.
  
  
  METHODS
  A 15-year old boy with 7 day history of abdominal pain, and bloody vomiting (1-2 x per day) without diarrhea. A suspicion of acute appendicitis was raised and the boy was operated on the 7th day since the initial symptoms. The appendix showed some reactive inflammation and was removed during laparotomy which also revealed enlarged mesenteric lymph nodes and a modest amount of fluid in the pelvic cavity. During the first day after the surgery, skin changes typical for HSP developed on lower limbs and buttocks.
  A 12-year old girl with 7 day history of abdominal pain, without diarrhea or vomiting. On the day of admission hemorrhagic rash appeared on lower limbs. Laparotomy was performed on 14th day after onset of abdominal pain - large amounts of serous, blood-stained fluid, massive dilation of small intestine with ecchymoses in mucous membrane, segmental infiltration and stiffening of intestinal wall were found. Normal appendix was removed.
  
  
  CONCLUSIONS
  Severe abdominal symptoms may precede skin changes in children with HSP, resulting in diagnostic and therapeutic challenges. When considering laparotomy in children with an atypical "acute abdomen" presentation, other manifestations of HSP should be sought.
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Mizerska-Wasiak
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw.
authors.forename: Piotr
authors.initials: P
authors.lastname: Skrzypczyk
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kisiel
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Pańczyk-Tomaszewska
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw.
authors.forename: Maria
authors.initials: M
authors.lastname: Roszkowska-Blaim
mesh_terms: D015746:Abdominal Pain; D000293:Adolescent; D001064:Appendicitis / Q000601:surgery; D002648:Child; D005260:Female; D006396:Hematemesis; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis* / Q000601:surgery; D007249:Inflammation; D007422:Intestines / Q000601:surgery*; D008297:Male
keywords: Henoch-Schönlein nephropathy; Henoch-Schönlein purpura; gastrointestinal symptoms; laparotomy