In Reply.—Dr Johansen's letter regarding our article concerning HSP is of interest. I believe he is focusing more than necessary on defending the right to perform a laparotomy in which the results are negative for suspected appendicitis. The differential diagnosis of abdominal pain in children is broad, and we agree with Dr Johansen that performing an operation for persistent localized right lower quadrant pain and tenderness is certainly an accepted surgical practice. The bottom line, however, is that children with HSP rarely have localized pain. Their pain is often diffuse and out of context with the clinical findings on physical examination. Furthermore, we could find only one case report of acute appendicitis coexisting with HSP. Appendicitis therefore almost never occurs with this condition.
Whether one wishes to use the term unproductive or unrevealing following a laparotomy in which the results are negative for suspected appendicitis is not the