Case ReportsInfarction of the choledochus, liver, gallbladder, and pancreas: A unique complication of the hemolytic uremic syndrome☆
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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Cited by (8)
Colonic stricture as a complication of haemolytic uraemic syndrome
2017, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Masumoto et al. [13] state that shiga-toxin induced microangiopathy is postulated to be the main cause of ischaemia, and the resulting ischaemic change results in stricture. Patients commonly present with abdominal pain, diarrhoea and haematochezia [8]. Serious sequelae include acute renal failure, with approximately 50% of patients requiring dialysis [1,4] in the acute phase.
Secondary sclerosing cholangitis and portal hypertension after O157 enterocolitis: Extremely rare complications of hemolytic uremic syndrome
2001, Journal of Pediatric SurgeryCitation Excerpt :Liver damage probably results from mild focal ischemic damage and subsides uneventfully.1,4,7 Hepatobiliary necrosis is extremely rare, and only 1 case has been reported in which the patient required distal pancreatectomy, liver resection, and excision of the extrahepatic bile duct with portoenterostomy.12 However, to our knowledge, no complications of secondary sclerosing cholangitis and subsequent cirrhosis with portal hypertension after recovery from HUS have been reported in the literature yet.
Extrarenal Manifestations in Shigatoxin-associated Haemolytic Uremic Syndrome
2016, Klinische PadiatrieSuccessful split liver-kidney transplant for factor H associated hemolytic uremic syndrome
2009, Clinical Journal of the American Society of NephrologyCommon bile duct stone associated with hemolytic uremic syndrome
2007, Archives of Iranian Medicine
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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.