Gastrointestinal Involvement as the Initial Manifestation in Children with Henoch-Schönlein Purpura-Clinical Analysis of 27 Cases

以腹痛為最初唯一臨床症狀之Henoch-Schönlein氏紫斑症病童—27例臨床分析

林思偕(Syh-Jae Lin) ； 趙舜卿(Hsun-Chin Chao) ； 黃璟隆(Jing-Long Huang)

《Acta Paediatrica Sinica》 39卷3期 (1998/06) Pp. 186-190

https://doi.org/10.7097/APS.199806.0186

摘要

我們回顧分析六年間27位以腹痛為最初唯一臨床表現而且出院診斷為Henoch-Schönlein氏紫斑症病童。其中有17位男孩，10位女孩，平均年齡為6.7±0.5歲。其腹痛症狀平均比皮疹早10.2±1.9天（3-48天）；臨床症狀包括臍周圍疼痛(77.8%)，嘔吐(51.9%)，腹瀉(29.6%)及血便(14.8%)，其中有六例其腹痛症狀類似盲腸炎(22.2%)。實驗室方面，多數病童有白血球增多(88.9%)，血小板增加(77.8%)，血清C反應球蛋白上升(71.4%)及糞便陽性潛血反應(77.8%)，腹部超音波有助於排除盲腸炎之可能性，上消化道內視鏡亦可提供診斷線索。三例接受不必要之剖腹手術，術後腹痛症狀依舊持續。85.2%之病人於皮疹出現時仍持續腹痛而接受類固醇治療，症狀均得以有效減輕。半年後追蹤除三例有輕微血尿外，餘全部痊愈。醫師於診治原因不明之急性腹痛病童應將此症列入考慮。早期使用類固醇或可減少病人之痛苦。

關鍵字

Henoch-Schönlein氏紫斑症 ； 腹痛 ； 兒童

並列摘要

A retrospective study was conducted to analyze the clinical and laboratory features, results of imaging studies, and course and treatment in 27 children with Henoch-Schönlein purpura (HSP) who initially presented with only abdominal symptoms. There were 17 boys and 10 girls, aged 6.7±0.5 years. The abdominal symptoms preceded the purpura for 10.2±1.9 days, ranging from 3 to 48 days. The main abdominal symptoms were periumbilical pain (77.8%); vomiting (51.9%); diarrhea (29.6%); pain mimicking appendicitis (22.2%) and bloody stool (14.8%). Laboratory findings revealed leukocytosis (88.9%), thrombocytosis (77.8%), positive stool guaiac tests (77.8%), and elevation of serum C-reactive protein (71.4%). Plain film is of limited use, but emergent abdominal sonography can be helpful in patients suspected of appendicitis. Unnecessary laparotomy was performed in three patients, whose pain persisted after the operation. Corticosteroid, given upon the appearance of rash, alleviated the abdominal pain in 2.4±0.2 days. All patients had recovered completely at six- month follow-up, except that three had persistent microscopic hematuria. A high index of suspicion and early diagnosis of HSP based on clinical features, laboratory data and the findings from diagnostic imaging may avoid unnecessary surgery. Early use of corticosteroid may reduce the suffering in these children.

並列關鍵字

Henoch-Schönlein purpura ； abdominal pain ； children