Clinical characteristics and associating risk factors of gastrointestinal perforation in children with IgA vasculitis

Qingyin Guo; Xiaolei Hu; Chundong Song; Xianqing Ren; Wensheng Zhai; Ying Ding; Xia Zhang; Meng Yang; Jian Zhang; Miao Jiang

doi:10.1080/07853890.2021.2009554

Clinical characteristics and associating risk factors of gastrointestinal perforation in children with IgA vasculitis

Ann Med. 2021 Dec;53(1):2315-2320. doi: 10.1080/07853890.2021.2009554.

Authors

Qingyin Guo¹, Xiaolei Hu², Chundong Song¹, Xianqing Ren¹, Wensheng Zhai¹, Ying Ding^{1

2}, Xia Zhang¹, Meng Yang¹, Jian Zhang¹, Miao Jiang¹

Affiliations

¹ First Affiliated Hospital of Henan University of Chinese Medicine, Henan Children's Hospital of Integrated Traditional Chinese and Western Medicine, Zhengzhou, China.
² Henan University of Chinese Medicine, Zhengzhou, China.

Abstract

Background: IgA vasculitis (IgAV) is a common small vessel vasculitis in children. Gastrointestinal perforation (GP) rarely presents as a complication of IgAV and is not well characterized. This study is aimed to investigate the clinical features, diagnosis, and risk factors of GP in children with IgAV.

Methods: We retrospectively reviewed the clinical data of children with IgAV who attended our hospital between January 2014 and June 2018. The clinical risk factors and the corresponding treatments were analyzed for the children with IgAV complication with GP.

Results: In total, 10,791 children with IgAV were reviewed in this study. GP was observed in 11 children with IgAV, accounted for 0.10% of the total cases. Among those GP patients, 1 case was gastric perforation, 10 cases were intestinal perforation. Five GP cases were identified by abdominal CT. Ultrasonography was failed to detect the occurrence of GP in five cases. The average duration of abdominal pain in the GP cases was 9.3 days, and 9 cases (81.8%) presented with abdominal pain for over 7 days. Gastric/intestinal perforation repair were performed for 3 IgAV GP cases under open surgery. The other eight cases were treated through enterectomy. In comparison with the patients without GP, the GP patients had significant higher rates in the aspect of the abdominal or mixed type of IgAV, abdominal pain duration more than 7 days, hematochezia, renal damage, and methylprednisolone treatment with the daily dosage more than 2 mg/kg.

Conclusion: GP children accounted for 0.10% of the total IgAV cases. The risk of GP is elevated in IgAV patients who has gastrointestinal symptoms and/or other symptoms such as hematochezia, renal damage, a prolonged abdominal pain (>7 days), administration of methylprednisolone (>2 mg/kg). Abdominal CT is highly recommended for the early detection of GP in IgAV patients.Key messagesGastrointestinal perforation (GP) rarely presents as a complication of IgAV and is not well characterized.11 out of 10,791 children with IgAV developed GP, accounting for 0.10% of the total number of cases.Abdominal CT is highly recommended for the early detection of GP in IgAV patients.

Keywords: Children; IgA vasculitis; gastrointestinal perforation; retrospective analysis; risk factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Humans
IgA Vasculitis* / complications
Immunoglobulin A
Retrospective Studies
Risk Factors
Vasculitis* / complications
Vasculitis* / diagnosis

Substances

Immunoglobulin A

Grants and funding

This work was supported by the Special Project of Chinese Medicine Scientific Research in Henan [2016ZY2030]. The funders had no role in the study design, data collection and analysis, data interpretation and in writing the manuscript.