HSP and Intussusception


We have discussed intussusception before and have noted that it can be a difficult diagnosis to make as the “classic” triad of colicky abdominal pain, vomiting, and currant jelly stools only occurs in 21% of cases.  Furthermore, the precipitating condition that produced the lead point that caused the intussusception can also distract you from making the diagnosis.  Is this colicky abdominal pain due to the viral illness the child has or is it due to telescoped intestine that started at the hypertrophied Peyer’s Patch?  Another great example of this is Henoch-Schonlein Purpura (HSP).

HSP is the most common vasculitis affecting children.

  1. It is self-limiting and generally resolves after ~4 weeks, but nephritis can persist.
  2. Clinical manifestations are due to widespread leukocytoclastic vasculitis from IgA deposition in blood vessel walls.
  3. Dominant Features (ARENA):
    1. Abdominal Pain (occurs in 65% of cases)
      1. May precede rash.
      2. Colicky pain, vomiting, and GIB are common (sounds like intussusception).
      3. May mimic acute surgical abdomen.
      4. Intussusception is rare, but known complication.
    2. Rash (occurs in 100% of cases)
      1. Sine qua non
      2. Purpura, classically palpable. Starts on legs and buttocks. Not itchy.
      3. Not associated with thrombocytopenia!
      4. May be preceded briefly by urticarial or maculopapular rash.
    3. Edema
      1. Angioedema of the scalp, eyelids, back, feet, and/or perineum.
      2. Less common in older children.
    4. Nephritis (occurs in 40% of cases)
      1. Hallmark is hematuria.
      2. Substantial proportion will have gross hematuria.
      3. May not develop for weeks to months after diagnosis (needs close follow-up).
      4. May become a chronic problem.
    5. Arthritis (occurs in 75% of cases)
      1. Commonly involves knees and ankles.
      2. Self-limiting and non-deforming.
      3. Can be severely painful.
      4. May precede the rash and, thus, confound diagnosis.


Intussusception and HSP

  1. Intussusception can be seen as a complication of HSP in 2-6% of cases.
  2. HSP associated intussusception generally occurs in children >2yrs of age.
  3. 70% occur in ileoileal locations, with only 30% being ileocolic (unlike typical intussusception, which occurs most commonly at ileocolic locations.
    1. Contrast enema may not diagnose it, because of the ileoileal location.
    2. Ultrasound is preferred imaging modality, augmented by serial examinations.
    3. Upper GI Series with small bowel follow-through may be necessary as well.


Saulsbury FT. Henoch-Schonlein Purpura. Current Opinion in Rheummatology: Jan. 2001; Vole 13(1). Pp.35-40.

Little KJ, Danzl DF. Intussusception associated with Henoch-Schonlein Purpura. The Journal of Emergency Medicine: 1991; Vole 9 (supp 1). Pp. 29-32.


Sean M. Fox
Sean M. Fox
Articles: 583


  1. My son had ileocolic intussusception at 8 weeks old, he had a laparotomy with ileocolic resection and anastomosis as well as an appendicectomy,
    Would he be at rist to reoccurance later on in life or anyprecautions i should take? Any advice would be greatly appericated

  2. My 4 yr old granddaughter has hsp and over the last 2+weeks has been vomiting(,mostly at nigh) has severe abdominal pain, bright red blood in her stool and is very lethargic. She was in the hospital from thurs until yesterday. She appeared to be on the mend until she woke up throwing up, diarrhea, pain this morning. They said they ruled intussusception out with the two ultrasounds but I’m not convinced it’s not. I’m very worried for my granddaughter because she’s never been still or quiet until now.please tell me what to do to get her some help before it’s too late. 9162165253

    • Well I am very sorry to hear of your family’s challenges right now!

      Naturally, I cannot give specific medical advice over the internet to individuals. That being said, if you are worried, it is always best to discuss your concerns with your pediatrician and the specialist who are caring for your family. I’d always advocate for extra communication when uncertain.

      All the best,

    • I cam across your post, and even tried to call the number. I bet it is cyclic vomiting syndrome and stomach migraines. It is brought on by an infection. It is very scary, my son has it. It took a long time to get diagnosed. The fact that her vomiting is mostly at night (same as my son) would be a big indicator of cyclic vomiting, because if it was an infection she would be vomiting all the time (but that can happen too). It can also cause severe constipation, which would lead to blood in stool–but he also had diarrhea too. My son had all of those symptoms. It is triggered by allergies, food, illnesses. It is not life threatening and can be managed with medication

  3. My son age 2 had HSP and intussusception with resulted in 13 inches of his small intestine being removed. My son is now 29 years old and the Neuro centre being treated for Susac Syndrome. Unlucky or could there be a connection?

  4. What if any are the complications of an Intussusception in later life ? My son had HSP and an Intussusception at age 2

    • Once it has been reduced, it should not lead to lasting issues. If there is an underlying cause of the intussusception (i.e., a lead point), then there may be related issues due to that cause.

      Hope your son is doing well,

  5. […] have previously discussed several kidney related issues: Hypertension Crisis, Kidney Stones, HSP, Rhabdomyolysis and Proteinuria. Wanting to remain vigilant for the big, bad, and ugly conditions […]

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