MULTIPLE ENTERO-ENTERO FISTULAS - AN UNUSUAL COMPLICATION OF HENOCH-SCHONLEIN PURPURA

Henoch-Schonlein purpura (HSP) is an immunologically mediated systemic vasculitis of small blood vessels that frequently involves the gastro intestinal tract, Surgeons often are asked to assess patients with HSP for abdominal pain. Common complications that lead to surgical interv ention include intussusception, perforation, necrosis, and massive gas trointestinal bleeding. However, the development of multiple entero en tero fistulae has not been described previously, Herein the authors de scribe the case of a 10-year-old girl with HSP who had a typical rash, seizures secondary to central nervous vasculitis, and gastrointestina l involvement. The abdominal pain persisted for several days until mar ked fever and hypotension developed, which necessitated surgical inter vention. During laparotomy, multiple entero-entero fistulae of the ile um were found, which required resection and primary anastomosis. Histo logical examination of the ileum was consistent with HSP vasculitis, T he patient made an unremarkable recovery and has had no recurrence of symptoms. Copyright (C) 1996 by W.B. Saunders Company