**5. Conclusion**

*Digestive System - Recent Advances*

*4.4.1 Imaging evaluation of gastrointestinal manifestation*

descending duodenum, stomach, and colon.

gastrointestinal symptoms develop prior to the cutaneous lesions.

obtained before steroid therapy is initiated, if possible [30].

of inflammatory disorders [31] (**Figure 3**).

enterocolitis, radiation enteritis, etc. [19].

mon findings [32].

*Upper gastrointestinal endoscopy* (UGD) is mandatory in patients with gastrointestinal bleeding. UGD is helpful in the diagnosis of IgA vasculitis, especially when

The most important part of upper gastrointestinal tract is involved in the second part of the duodenum with endoscopic features including diffuse mucosal redness, petechiae, severe erosive duodenitis, hemorrhagic lesion, and ulcers [28] (**Figure 2**). Purpuric lesions may be seen on an endoscopy, commonly in the

The spectrum of upper endoscopic findings is based upon the severity of the vasculitis; usually, irregular, ulcerating, nodular lesions or hematoma-like protrusions are characteristic of IgA vasculitis in the duodenum. The stomach and colon are often involved as well, but the duodenal bulb is rarely affected; the absence of bulbar lesions is important to exclude the cause of the peptic disease hemorrhage [29]. The biopsies of gastrointestinal lesions are commonly performed in patients with or without suspected IgA vasculitis in order to rule out infection, inflammatory bowel disease, and less commonly, vasculitis. In general, vasculitis is not commonly observed in GI biopsies, and the spectrum of findings includes neutrophilic infiltrate within the small bowel and colon, with the duodenum most commonly affected. While the clinical and histologic findings may mimic early inflammatory bowel disease, the presence of predominant small bowel involvement, especially erosive duodenitis, should raise suspicion for IgA vasculitis. Biopsies should be

Resolution of duodenal lesions is spectacular, in accordance with the remission

*Colonoscopy*: erythema of the mucosa, petechiae, and ulcers are the most com-

*Computed tomography (CT) imaging:* the hallmarks of IgA vasculitis are multifocal symmetric, circumferential, regular wall thickening and engorgement of mesenteric vessels. Associated findings include free intraperitoneal fluid, ileus of the affected loop, vascular engorgement in the adjoining mesentery, and nonspecific lymphadenopathy [24]. The target sign is not specific; it can be seen in many other conditions such as ischemic bowel disease, inflammatory bowel disease, infectious

In some selected cases, CT angiography can be used to visualize the site of the arterial or venous occlusion; however, a normal angiogram does not rule out the possibility of mesenteric ischemia [3]. Mesenteric vascular engorgement and skip areas are also seen in Crohn's disease, but terminal ileal involvement, stricture, fistula, and abscess would favor Crohn's disease over other conditions [12, 33].

*Endoscopic appearance of the second part of duodenum: multiple erosions, diffuse redness, submucosal* 

**40**

**Figure 2.**

*hemorrhage, and small ulcerations.*

The diagnosis of IgA vasculitis (HSP) is usually based upon clinical manifestations of the disease, and in patients with an incomplete/unusual presentation, biopsy of the affected organ (e.g., skin or kidney) demonstrating predominantly IgA deposition supports the diagnosis. Although gastrointestinal involvement is frequent, the diagnosis of IgA vasculitis may be difficult when gastrointestinal manifestations occur alone or precede the characteristic skin purpura.
