Colonic stricture secondary to hemolytic uremic syndrome caused by Escherichia coli O-157

Abstract

Shiga toxin-producing Escherichia coli (E. coli) is known to be one of the main causes of hemolytic uremic syndrome (HUS). Of the secondary complications of HUS, colonic stricture is relatively rare. We herein report on a Japanese girl that demonstrated sigmoid colon stricture secondary to HUS caused by an infection of E. coli O-157. Severe HUS occurred after the E. coli O-157 infection, so hemodialysis was performed due to renal failure. However, 1 month after recovery from HUS, abdominal symptoms occurred. A contrast study in the colon revealed a sigmoid colon stricture. The stricture was operatively resected. Thereafter, her postoperative course was uneventful. We also review the occurrence of this complication secondary to HUS in the literature.

Gastrointestinal Dysfunction Following Hemolytic Uremic Syndrome

“…Late-onset strictures additionally show scarring and adhesion formation. These late-onset findings, still unclear in etiology, are thought to be a result of continued chronic inflammatory changes in the bowel itself [2,5]. The additional abnormalities of small bowel function found in this patient have not been previously described.…”

“…Seventeen cases of colonic stricture formation have been reported, including the current case [2]. Prior to this case, the longest reported interval between the acute phase of the illness and the onset of colonic stricture was 5 years [2]. There have been no reports of ongoing gastrointestinal complications or dysfunction following successful stricture resection.…”

“…In rare cases, a colonic stricture has been documented as a complication. Seventeen cases of colonic stricture formation have been reported, including the current case [2]. Prior to this case, the longest reported interval between the acute phase of the illness and the onset of colonic stricture was 5 years [2].…”

“…The etiology of early (\1 year after HUS) and late-onset strictures may be different. Strictures that occur early are histologically characterized by mucosal ulceration, granuloma formation, edema, and fibrosis in all of the submucosal layers [2,4]. Late-onset strictures additionally show scarring and adhesion formation.…”

Gastrointestinal Complications of Post-Diarrheal Hemolytic Uremic Syndrome

“…Loirat et al [13] reported 1 % of cases in whom gastrointestinal complications required surgery, and in his study, Bernard et al [3] reported 5%: one case of colonic necrosis and one with intestinal intussusception. One case of colonic stricture post HUS was also described [17]. Colonic stenosis is a known complication of severe colitis [4,15].…”