SEVERE COLECTASY IN THE COURSE OF SCHONLE IN-HENOCH PURPURA - PROBABLE RESPONSIBILITY OF WATER-SOLUBLE CONTRAST-MEDIA

Background. About 60-70% of cases of anaphylactoid purpura suffer from abdominal colic, which may be quite severe. Because severe abdominal pain may be difficult to differentiate from a surgical abdomen, repeat ed examination and radiological studies are often necessary. Case repo rt. A 4 year 7 month-old girl suffered from abdominal pain, vomiting a nd the skin rash characteristic of anaphylactoid purpura. Because of w orsening of the abdominal manifestations, a Gastrografin(R) enema was given. The result was normal but 48 hours later, the child suffered fr om acute abdominal colics plus symptoms of shock. X-ray examination re vealed a large distension of colon and persistence of the contrast mat erial. Exploratory laparotomy failed to find any perforation or necros is. The colon was drained and the child was given parenteral nutrition and antibiotics. Blood culture showed Klebsiella pneumoniae. An upper gastrointestinal roentgenogram using meglumine ioxitalamate was perfo rmed 19 days later because of recurrence of the abdominal pain. This s howed a submucosal hemorrhage in the first small bowel loop. Increased abdominal distension occurred 3 days later and the results of X-rays were similar to those seen the Gastrografin(R) enema. A second enema u sing meglumine ioxitalamate was performed 3 days later. It showed sigm oid constriction but a second laparotomy failed to confirm this obstru ction. The child died a few hours later despite ileostomy and antibiot ics. Conclusions. The severe colectasy seen in this case of anaphylact oid purpura indicates that caution is required in performing enemas in acute digestive complications of this disease. Such X-ray studies sho uld not be repeated and all water-soluble contrast material should be voided as soon as possible.