Clinical Practice and Cases in Emergency Medicine

Introduction: Immunoglobulin A (IgA) vasculitis, formerly known as Henoch–Schönlein purpura, is a small-vessel leukocytoclastic vasculitis caused by IgA immune complex deposition. While it is the most common systemic vasculitis in children, adult cases can present with more severe systemic manifestations. The classic clinical tetrad includes palpable purpura, arthralgia, abdominal pain, and renal involvement. Gastrointestinal symptoms, occurring in approximately two-thirds of cases, result from inflammation of small bowel vessels resulting in bowel wall edema and hemorrhage, which may serve as lead points for intussusception.

Case Report: A 21-year-old male presented with two days of severe periumbilical abdominal pain, bilateral knee pain, and a nonblanching palpable purpuric rash on his lower extremities. Physical examination revealed a soft but tender abdomen. Lab results were remarkable for leukocytosis. Computed tomography (CT) of the abdomen and pelvis demonstrated small bowel wall thickening and ileoileal intussusception. The patient was initially consented for a partial ileal resection; however, an exploratory laparotomy failed to localize the telescoping segment, suggesting spontaneous resolution. He was observed for 24 hours and discharged with outpatient follow-up.

Conclusion: Intussusception is the most common surgical complication of IgA vasculitis. In adults, this condition requires high clinical suspicion and prompt diagnostic imaging with ultrasonography or CT, as small bowel involvement may be inaccessible by contrast enema. This case underscores the importance of recognizing IgA vasculitis-associated intussusception as a critical and potentially self-limiting complication in the adult population.