henoch  schnlein purpura ( hsp ) belongs to the group of nongranulomatous small vessel vasculitis .
intussusception , gangrene of the bowel , bowel perforation , and massive hemorrhage are the most common gastrointestinal complications of hsp .
a comprehensive search of pubmed , embase , and web of science was performed for all relevant papers published before july 1 , 2015 . because the full text of six articles was unavailable , only 13 cases described in 12 full - text articles were included in this study .
then , we investigated the clinical features , treatments , and prognoses of hsp - related pancreatitis cases .
the main clinical characteristics of the 13 patients ( six males , seven females ) are summarized in table 1 .
the patients ranged in age from 3 to 70 years , half of cases were 520 years old .
pancreatitis presented as the initial manifestation of hsp in eight cases . in addition , pancreatitis and typical purpura occurred at the same time in the two cases . from the onset of pancreatitis to the diagnosis of hsp , the time elapsed ranged from 1 day to 75 days , and 62.5% ( 5/8 ) of the patients began to have typical purpura within 7 days of the onset of pancreatitis .
in addition to abdominal pain in all cases , seven patients presented with vomiting , one patient had hematemesis , one patient had hematochezia , and one patient had poor appetite .
iu / l ) in all cases . abdominal computed tomography ( ct ) revealed pancreatic edema , ascites , and a wide range of intestinal wall edema in seven cases .
a pancreatic cyst was found in one patient , it appeared over the course of 35 days and disappeared in 55 days ; however , five patients did not demonstrate any morphological changes in the pancreas .
all patients experienced relief through treatment with fasting , gastrointestinal decompression , nutritional support , antiacid drug , glucocorticoid , and somatostatin . the abdominal pain relief time ( 144 days ) was noted in six cases .
patient prognoses were described in three cases , and these patients were cured without recurrence through follow - up .
main clinical characteristics of 12 previously reported cases of henoch - schnlein purpura - related pancreatitis
hsp occurs about twice as often in boys as in girls , half of affected patients are younger than 10 years of age .
however , our study suggested that hsp - related pancreatitis usually occurs in adolescent girls .
the reason remains unclear ; it may be associated with the immune state of adolescent girls .
compared with other types of pancreatitis , hsp - related pancreatitis has the following characteristics . in our study , before the onset of hsp - related pancreatitis , there was no prominent cause , such as biliary tract disease , overeating , drinking , hyperlipidemia , viral infection , or drugs .
we speculate that hsp - related pancreatitis may be associated with small blood vessel thrombosis , vasculitis , and intimal thickening .
although the clinical manifestation was relatively mild , acute pancreatitis may be the initial manifestation of hsp .
hsp - related pancreatitis is diagnosed clinically but requires ct evaluation or ultrasound imaging to differentiate mild acute pancreatitis from severe necrotic pancreatitis . in our study , approximately 41.7% ( 5/12 ) of the patients with pancreatic morphology were normal , and only 41.7% of the patients presented with pancreas swelling .
the imaging changes in hsp - related pancreatitis were atypical , and pancreatic necrosis or pseudocysts and other local complications were relatively rare . in our study , all patients had elevated serum amylase and urine amylase levels , with an increase of at least three times the upper limits in blood and urine , but the level was not positively correlated with the disease severity . some researchers believe that elevated amylase creatinine clearance and serum lipase levels are appropriate for the early diagnosis of pancreatitis .
it has been reported that the measurement of plasma factor xiii could be useful for the early diagnosis of hsp , particularly when the typical purpura is preceded by abdominal pain .
in addition to the conventional treatment for pancreatitis , more attention should be paid to hsp . in our study , the symptom of pancreatitis was improved after steroid treatment in all patients .
somatostatin can inhibit gastric and pancreatic secretions , thereby reducing enzymatic activity ; it can also reduce capillary permeability , open the sphincter of oddi , and promote the excretion of pancreatic enzyme . after a diagnosis of hsp - related pancreatitis
in addition to the symptomatic and supportive treatment , the use of corticosteroids to control hsp helps to alleviate hsp - related pancreatitis .
 to summarize the experience of diagnosing and treating patients with henoch  schnlein purpura ( hsp)-related pancreatitis , a systematic review of previously published cases was conducted . among 13 reported cases , 
 there were six males and seven females whose age from 3 to 70 years . 
 the clinical features of these patients indicated that acute pancreatitis could be the initial manifestation of hsp , the radiological change was atypical , and most cases were alleviated with steroidal treatment . 
 good outcomes can be achieved in patients who are diagnosed early with hsp - related pancreatitis , and it is vital to begin timely treatment of hsp - related pancreatitis with corticosteroid . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
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