Abdominal Type Allergic Purpura:a Salvage Treatment Following Twice Exploratory Laparotomy

WU Ming-hui; ZHANG Dong; YANG Xiao-li; JIAO Xiao-jing; HAN Qiu-xia; ZHU Han-yu

doi:10.3969/j.issn.1002-3429.2018.01.024

Abstract：Objective To summarize clinical features and causes of misdiagnosis of abdominal type allergic purpura so as to reduce its clinical misdiagnoses and mistreatment. Methods The clinical data of a patient misdiagnosed with acute abdomen ( acute appendicitis, hemorrhagic enteritis) who underwent twice exploratory laparotomy were analyzed retrospectively at the Chinese PLA General Hospital ( the Hospital thereafter) . Results The 56-year-old patient was transferred to the Hos-pital due to purpura on lower limbs for 13 days, abdominal pain for 9 days when the symptoms had worsened for 3 days. Before admission, the patient had been misdiagnosed by another hospital as acute appendicitis for abdominal pain and had undergone appendectomy. However, the patient's abdominal pain and abdominal distension had aggravated after the surgery. Later the patient had been diagnosed as hemorrhagic enteritis and the exploratory laparotomy and ileostomy had been performed thereaft-er. Since his abdominal pain and skin petechiae had not relieved yet, the patient was transferred to the Hospital. Here he was diagnosed as abdominal type allergic purpura after consultation with specialists from various departments and combination with patient history, physical examination, postoperative drainage fluid and biochemical examination results. Treated with high-dose glucocorticoid, immunoglobulin and other symptomatic approaches, the patient improved gradually after 3 days and was clinically cured and discharged from hospital after 12 days. Conclusion Abdominal type allergic purpura is prone to be mis-diagnosed as acute abdomen and be treated surgically, which suggests that clinicians should comprehensively analyze its symp-toms, examine carefully and especially pay attention to skin petechiae,so as to avoid unnecessary surgery.