Oesophageal and severe gut involvement in the haemolytic uraemic syndrome

Abstract

Between 1982 and 1989, 78 children with diarrhoea-associated haemolytic uraemic syndrome (HUS) were referred to this hospital. Most presented with abdominal pain, bloody diarrhoea and vomiting. Seven had severe gastrointestinal involvement, four of whom required resection for bowel perforation or necrosis. One also developed an oesophageal stricture, a previously unreported complication of HUS. These seven children had a high incidence of other complications including hypertension, and cerebral and pancreatic involvement. One died from severe cerebral involvement, one has a residual neurological deficit and one has residual renal impairment. Severe gastrointestinal involvement did not significantly affect the long-term outcome. Simple haematological indices helped predict severe gut involvement. Four of the 78 children had undergone appendicectomy before the diagnosis of HUS was made. The operative findings were in no case typical of primary acute appendicitis, although histological examination did confirm inflammation of the appendix in two patients. Diagnosis is difficult in early disease, but increased awareness may help prevent unnecessary appendicectomy.

Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome

“…Some have proposed that it is related to the initiation of peritoneal dialysis with glucose solutions or to the use of medications such as glucocorticoids or diazoxide. This is unlikely, as the hyperglycemic effects of diazoxide are transient (46); some patients never received glucocorticoids (18,19,25,26,28,30,31), diazoxide (18,19,25,26, 29 -31,33), or peritoneal dialysis (20,30); and one patient developed diabetes before peritoneal dialysis was instituted (18). It is possible that the children may have had "stress hyperglycemia" rather than true diabetes (47).…”

Acute appendicitis in a patient with hemolytic uremic syndrome: an unusual clinical scenario

“…Yet, only 2.4% of these children ultimately required surgical intervention. De la Hunt et al [8] upon review of children with E. coli O157:H7 infection found that 53% experience abdominal pain, and 81% vomiting. Five percent of these patients underwent surgery for complications of severe gastrointestinal involvement, mainly segmental intestinal necrosis and/or perforation.…”

Shiga toxin-associated hemolytic uremic syndrome complicated by intestinal perforation in a child with typical hemolytic uremic syndrome

“…It is helpful to know that colonic perforation rarely occurs within the first week of the disease but instead much later9). In severe HUS, indications of surgical exploration include toxic megacolon, colonic perforation, acidosis unresponsive to dialysis, or recurrent signs of obstruction or colonic stricture11,12); Therefore, it is important to keep in mind the possibility of intestinal perforation when the gastrointestinal symptoms of patients with HUS do not improve. In these cases, prompt surgical exploration is necessary.…”