A Case of Successful Colectomy for Hemorrhagic Colitis with Hemolytic Uremic Syndrome, due to Escherichia Coli O-157 Infection

Kiyotomi Maruyama, Yasuo Yamazaki and Kenji Uchida

Department of Surgery, Ageokohsei Hospital

A 58-year-old female was admitted for lower abdominal pain and bloody diarrhea. Two days after administration, she had frequent bloody diarrhea with aggravation of her renal function (BUN 42.4 mg/dl, Cr 3.4 mg/dl). Physical examination revealed severe tenderness, rebound tenderness and slight muscle guarding in the right lateral abdominal region. CT scan showed severe thickness and edema of the wall in the right colon and massive ascites in the lower abdomen. We diagnosed hemorrhagic colitis with acute renal failure, with a risk of panperitonitis. We conducted a wide right hemicolectomy. We performed postoperative extracorporeal elimination of endotoxins and continuous hemodiafiltration. A feces culture failed to show growth of Escherichia coli O-157. Blood studies, however, included a positive result for the O-157 antibody. The patient was discharged on postoperative day 78. This is one of the successful cases of surgical therapy for hemorrhagic colitis with hemolytic uremic syndrome.

Key words
surgical treatment, Escherichia coli infection, hemolytic uremic syndrome

Reprint requests
Kiyotomi Maruyama Department of Surgery, Ageokohsei Hospital
421-1 Jitohgata, Ageo-city, 362-0051 JAPAN

Accepted
October 29, 2003

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