Clinical Characteristics and Risk Factors of Gastrointestinal Perforation in Children with Henoch-Schönlein Purpura

Background: Henoch-Schönlein purpura (HSP) is a common small vessel vasculitis in children. Gastrointestinal perforation (GP) rarely presents as a complication of HSP and was not well characterized. This study aimed to investigate the clinical features, diagnosis and risk factors of GP in children with HSP. Methods: We retrospectively reviewed the clinical data of 10791 children with HSP who attended our hospital between January 2014 and June 2018 and analyzed the treatment and clinical risk factors of 11 children with HSP complication with GP. Results: GP occurred in 11 children with HSP, with an incidence of 0.10%. Among the 11 cases HSP with GP, 1 case was gastric perforation and 10 cases were intestinal perforation. CT indicates perforation but ultrasonography did not indicate perforation in 5 cases of GP patients. The average duration of abdominal pain in HSP with GP was 9.3 days, and 9 cases (81.8%) with a duration of abdominal pain over 7 days. 3 cases of HSP with GP were treated by gastric/intestinal perforation repair and the other 8 cases were treated by enterectomy. The type of purpura, abdominal pain lasting more than 7 days, hematochezia, renal damage, and methylprednisolone dose more than 2mg/kg in GP with HSP patients show statistically significant compared with the control group (P<0.05). Conclusion: The incidence rate of GP in children with HSP was 0.10%. Abdominal (or mixed) HSP, hematochezia, renal damage, abdominal pain lasting more than 7 days, and methylprednisolone dose more than 2mg/kg may increase the risk of GP in children with HSP. CT has a high sensitivity for the diagnosis of GP. Early diagnosis and timely treatment of HSP with GP were very important for good clinical outcomes.