Henoch-Schonlein purpura: duodenojejunal enteritis

Case contributed by Dr Ian Bickle

Presentation

Diarrhoea, diffuse abdominal pain and some PR blood. Purpuric facial rash and on arms. Later developed small joint arthralgia.

Patient Data

Age: 55 years
Gender: Male

The duodenum from the D2-D3 junction distally and a long length of jejunum is thick-walled with hyperenhancing mucosa. Perienteric and mesenteric inflammatory change.

Small volume ascites in upper abdomen and pelvis.

No free gas or collection.

No visceral vessel thrombosis.

Simple hepatic cysts.

 

OGD performed one week after CT: haemorrhagic gastritis and duodenal ulceration.

The histology from the duodenum correlates with the clinical suspicion in this patient and marries with the CT findings.

Case Discussion

The CT appearances are suggestive of a long segment of duodenojejunal thickening of inflammatory origin.  A less common place for typical inflammatory bowel disease.

Important given these non-specific features to correlate with the clinical findings and ultimately endoscopic assessment and biopsy.

Patient age is also atypical for Henoch-Schonlein purpura, being older than usual.

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Case information

rID: 47153
Case created: 2nd Aug 2016
Last edited: 6th Feb 2018
Inclusion in quiz mode: Included
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