Reversible Gastrointestinal Signs of Hemorrhage and Edema in the Pediatric Age Group

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Abstract
Reversible changes in the gastrointestinal tract of adults due to bleeding and edema have been described clinically (11, 14) and produced experimentally (11). It is not unexpected that examples should be found in the pediatric age group of diseases of diverse etiology with common roentgen manifestations, relating to hemorrhage, ischemia, edema, and necrosis with return to normal. Schönlein-Henoch purpura, giant hemangioma with platelet trapping, classic hemophilia, and postoperative ischemia of a colonic transplant for reconstructing the esophagus in esophageal atresia have all presented with signs of gastrointestinal bleeding and examples of “thumbprinting” and “pseudotumor” defects on barium studies. Schönlein-Henoch purpura (nonthrombocytopenic purpura) In children with Schönlein-Henoch nonthrombocytopenia or anaphylactoid purpura, swollen painful joints, cutaneous purpura, and abdominal pain with associated bleeding from the intestinal tract are characteristic. The abdominal pain, often colicky, may precede the cutaneous and joint manifestations. Surgical exploration, when an acute abdomen has been suspected, has revealed swollen edematous hemorrhagic loops of small bowel. The intestine may grossly resemble an acute regional enteritis. Gastrointestinal studies with nonflocculating barium (Baroloid) have revealed a diffuse involvement of the small intestine with dilated and separated loops, and marginal polypoid defects (“pseudo-tumor” or “thumbprinting”). When the patients have been re-studied in three to four weeks the intestinal pattern has returned to normal (5). Case I: An 8-year-old white male was admitted to Babies Hospital with a four-day history of generalized abdominal pain, rectal bleeding, purpura, and swollen joints. No recent toxin exposure, infection, allergic history, or drug ingestion was noted. Coagulation studies were normal; stool guaiacs were 2+ to 4+. Bone-marrow showed normal megakaryocytes. Small-intestinal barium examination (Fig. 1) disclosed the entire midgut from the ligament of Treitz to the ileocecal valve to be involved; dilated, separated loops had loss of normal mucosal detail with polypoid marginal defects. Steroids were not administered; the patient became asymptomatic and one month later (Fig. 2) he was normal, and the abnormal roentgen signs had disappeared entirely. It had been noted previously that the less severe the clinical signs of abdominal pain and blood per rectum, the less marked were the manifestations of bleeding and edema in the small-bowel roentgenograms (5). The Schönlein-Henoch syndrome is a vasculitis; as such it produces hemorrhage, edema, and even necrosis. Intussusception may occur, though in the majority of patients studied roentgenographically there has been no such involvement.