Case Reports
Infarction of the choledochus, liver, gallbladder, and pancreas: A unique complication of the hemolytic uremic syndrome

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Abstract

Hemolytic uremic syndrome (HUS) is associated with multiple nonrenal manifestations. A unique case is described of a 3-year-old boy who presented with a classic diarrheal prodrome followed by massive necrosis of the biliary tree and common bile duct, pancreas, and the left lobe of his liver. This complication of HUS has not been reported in the English-language literature. J Pediatr Surg 35:502-504. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Case report

A 3-year-old white boy presented with progressive vomiting and intermittent bloody diarrhea for 5 days. On examination he was found to be in shock with lethargy and confusion. He was intubated, resuscitated, and admitted to the intensive care unit. Initial laboratory results were consistent with HUS: hemoglobin, 7.8 g/dL; platelet count, 20,000/μL; creatinine (Cr), 1.6 mg/dL; and blood urea nitrogen (BUN), 60 mg/dL. Other studies included a white blood cell count (WBC) of 41,000/μL; bicarbonate

Discussion

HUS results from a microangiopathic hemolytic process that leads to endothelial cell injury and vascular thrombosis. Symptoms range from a subclinical illness to a fulminant life-threatening process. HUS primarily manifests as acute renal insufficiency. Systemic manifestations are protean and include hemorrhagic colitis, disseminated intravascular coagulopathy, cardiomyopathy,11 respiratory illness, and encephalopathy.12 Gastrointestinal symptoms often are the presenting complaint, as seen in

Acknowledgements

The authors acknowledge Frederick Ryckman, MD, Children's Hospital Medical Center, Cincinnati, OH, who revised the strictured portoenterostomy.

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    Address reprint requests to Diane W. McCarthy, MD, Children's Hospital, ED 379, Department of Pediatric Surgery, 700 Children's Dr, Columbus, OH 43205.

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