Surgical management of small bowel-small bowel intussusception in Henoch-Schönlein Purpura

Abstract Henoch-Schonlein Purpura (HSP) is the most common vasculitis seen in children. It is characterized by rash, joint pain, and renal disease. Abdominal findings requiring surgical intervention are uncommon. A 13-year-old male presented to the emergency department with abdominal pain, new onset bilious emesis, and rash after three weeks of flu-like symptoms. Five days prior, he received treatment for strep pharyngitis from his primary care provider. A diagnosis of HSP was made after abdominal CT scan revealed signs of duodenal inflammation and a non-obstructing small bowel-small bowel intussusception. His abdominal pain persisted, and repeat ultrasound revealed persistence of the intussusception with concerns for decreased blood flow to the intussuscepted bowel. He was taken to the operating room for reduction of the intussusception. Vasculitic lesions were visualized within the duodenal mucosa and on the serosa of the small and large bowel. These rare operative images are presented below. The intussusception was reduced without need for resection. In HSP, intramural hemorrhage and submucosal inflammation can create lead points that trigger small bowel intussusceptions to occur. These intussusceptions are typically managed supportively and rarely require surgery. We present a case of HSP requiring surgery with depictions of both mucosal and serosal based vasculitis lesions.