Henoch-Schönlein Purpura (Differential Diagnosis as before)

anus_17a_n.jpg: Right buttock of a schoolchild with scattered petechial and mainly larger and palpable efflorescences of different size. The diagnosis is a Henoch-Schönlein purpura which is characterized by petechial and palpable skin hemorrhages and other types of exanthema, periarticular swellings, abdominal colics, and blood in the stool. The blood in the stool is due to a vasculitis of the gastrointestinal tract while the colics are due to diffuse edema and hemorrhages of the intestinal wall. The latter may lead to a symptomatic intussusception. Therefore, one is never absolutely sure if the recurrent blood evacuation by the anus and abdominal colics are due to the Henoch-Schönlein purpura or due to a combined symptomatic invagination. In addition, ultrasound and contrast enema are not suitable for the diagnosis of intussusception situated in the small intestine. anus_17b_n.jpg: Laparotomy in a 9-year-old boy with abdominal signs and symptoms of Henoch-Schönlein purpura. Besides the diffuse and punctate hemorrages of the mesentery and serosa the intestinal loop on the right side which is demonstrated by the surgeon is bluishly discolored and irregularly increased in volume in contrast to the segment on the left side. The diagnosis is symptomatic ileoileal intussusception; the head of the invagination has been moved in the picture from the right to the left side in a distal direction by the surgeon.