Surviving Case of Hemolytic Uremic Syndrome with Severe Acute Hemorrhagic Enterocolitis

Jun-ichi Nakamura, Seiichi Takenoshita, Hiroshi Koitabashi, Kazuhisa Katayama, Ryouji Katoh, Hiroyuki Katoh, Yukio Nagamachi

First Department of Surgery, Gunma University School of Medicine

Hemolytic uremic syndrome (HUS) is characterized by a triad of features: acute renal failure, thrombocytopenia and microangiopathic hemolytic anemia. A 4-year-old girl presented with hemolytic uremic syndrome following a prodrome of bloody diarrhea. No organism was cultured from the patient's stool at admission. However, because of the high titer of anti-Verocytotoxin 2 and anti-E. coli serotype O157 in the patient's serum, we diagnosed this case as HUS induced by infection of Verocytotoxin-producing E. coli. The patient developed severe renal failure. Bloody ascites and necrosis of colon were found a laparotomy performed to implant a continuous ambulatory peritoneal dialysis (CAPD) catheter. Partial resection of the transverse colon and colostomy were performed. Microscopic examination revealed embolisation of small vessels in the submucosal region. We successfully performed colostomy closure 16 months after she recovered from the first operation.

Key words
hemolytic uremic syndrome, necrotizing colitis, enterohemorrhagic E. coli

Reprint requests
Jun-ichi Nakamura First Department of Surgery, Gunma University School of Medicine
3-39-22 Shouwa-machi, Maebashi, 371 JAPAN

Accepted
April 14, 1993

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