Henoch Schonlein purpura mimicking Crohn's ileitis.

Henoch Schonlein Purpura (HSP) is a systemic vasculitis of small sized vessels commonly seen in childhood and characterized by purpuric rashes, arthritis, gastrointestinal (GIS) and renal manifestations. GIS involvement is common, however, intestinal perforation, necrosis, strictures and intussusceptions occur very rarely.1 Such complications usually occur in the early childhood and have been reported in the adults very rarely.2–4 In this report we describe a young patient presenting with acute abdomen. Intestinal obstruction was the preceding finding and the skin rashes appeared at the post-operative follow-up. An 18-year-old male without having previous GIS symptoms was admitted to the emergency care unit with severe abdominal pain, nausea, vomiting and obstipation for two days. At physical examination, he had rebound tenderness on the right lower abdominal quadrant. Laboratory examinations were normal other than leukocytosis (18.000/ml). Abdominal X-ray film showed multiple fluid–gas levels. Abdominal ultrasonography showed free intraperitoneal fluid among bowel segments. At contrast enhanced abdominal computerized tomography (CT) there was thickening of the ileum wall and thereby nearly total obstruction of its lumen (Fig. 1). With these findings the patient was diagnosed as acute abdomen and underwent urgent operation. Intra-operative investigation revealed 300 cc free intraperitoneal serous fluid. During exploration, the serosal layer of ileum was hyperemic (15 cm in length). The wall was thickened and there was an