Henoch-Schonlein purpura is a systemic vasculitis of unknown etiology that is probably related to autoimmune phenomenon. Henoch-Schonlein purpura is characterized by purpuric rash, arthragia, nephritis, and gastrointestinal manifestations. We reviewed 169 children hospitalized with a diagnosis of Henoch-Schonlein purpura at Asan Medical Center between 1989 and 1998. One- hundred thirty-nine (82.2%) had gastrointestinal manifestations including abdominal pain, nausea, vomiting and gastrointestinal bleeding. Surgical consultations were obtained for ten children, and laparotomy was performed on five children. Three children suspected of appendicitis underwent appendectomy. None had the evidence of appendicitis. One child who was suspected of intestinal strangulation revealed, in pathologic review, the hemorrhagic edema of the proximal jejunum and of the distal ileum at laparotomy. Another child underwent resection for hemorrhagic infarct of distal ileum. High suspicion of this disease entity in differential diagnosis of abdominal pain in children can avoid unnecessary laparotomy in most cases. However, the life-threatening gastrointestinal complications may occur in a small percent of cases. The prompt recognition and adequate radiologic evaluation of abdominal manifestation of this entity is needed for an early surgical intervention.