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Grinlinton M, Evans S, Kara T. Colonic stricture as a complication of haemolytic uraemic syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Igarashi T, Ito S, Sako M, Saitoh A, Hataya H, Mizuguchi M, Morishima T, Ohnishi K, Kawamura N, Kitayama H, Ashida A, Kaname S, Taneichi H, Tang J, Ohnishi M. Guidelines for the management and investigation of hemolytic uremic syndrome. Clin Exp Nephrol 2016; 18:525-57. [PMID: 25099085 DOI: 10.1007/s10157-014-0995-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Takashi Igarashi
- National Center for Child Health and Development (NCCHD), 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan,
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Chang HJ, Kim HY, Choi JH, Choi HJ, Ko JS, Ha IS, Cheong HI, Choi Y, Kang HG. Shiga toxin-associated hemolytic uremic syndrome complicated by intestinal perforation in a child with typical hemolytic uremic syndrome. KOREAN JOURNAL OF PEDIATRICS 2014; 57:96-9. [PMID: 24678335 PMCID: PMC3965802 DOI: 10.3345/kjp.2014.57.2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/12/2012] [Accepted: 10/18/2012] [Indexed: 12/03/2022]
Abstract
Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.
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Affiliation(s)
- Hye Jin Chang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hwa Young Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hong Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Gastrointestinal dysfunction following hemolytic uremic syndrome. Dig Dis Sci 2011; 56:2241-3. [PMID: 21559739 DOI: 10.1007/s10620-011-1733-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 04/17/2011] [Indexed: 01/08/2023]
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Affiliation(s)
- D Devadason
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
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Masumoto K, Nishimoto Y, Taguchi T, Tsutsumi Y, Kanemitsu S, Hara T, Suita S. Colonic stricture secondary to hemolytic uremic syndrome caused by Escherichia coli O-157. Pediatr Nephrol 2005; 20:1496-9. [PMID: 15973523 DOI: 10.1007/s00467-005-1996-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 04/26/2005] [Accepted: 04/26/2005] [Indexed: 11/28/2022]
Abstract
Shiga toxin-producing Escherichia coli (E. coli) is known to be one of the main causes of hemolytic uremic syndrome (HUS). Of the secondary complications of HUS, colonic stricture is relatively rare. We herein report on a Japanese girl that demonstrated sigmoid colon stricture secondary to HUS caused by an infection of E. coli O-157. Severe HUS occurred after the E. coli O-157 infection, so hemodialysis was performed due to renal failure. However, 1 month after recovery from HUS, abdominal symptoms occurred. A contrast study in the colon revealed a sigmoid colon stricture. The stricture was operatively resected. Thereafter, her postoperative course was uneventful. We also review the occurrence of this complication secondary to HUS in the literature.
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Affiliation(s)
- Kouji Masumoto
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
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Rebouissoux L, Llanas B, Jouvencel P, Dobremez E, Brun M, Fayon M, Lamireau T. Pancreatic pseudocyst complicating hemolytic-uremic syndrome. J Pediatr Gastroenterol Nutr 2004; 38:102-4. [PMID: 14676604 DOI: 10.1097/00005176-200401000-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Murray KF, Patterson K. Escherichia coli O157:H7-induced hemolytic-uremic syndrome: histopathologic changes in the colon over time. Pediatr Dev Pathol 2000; 3:232-9. [PMID: 10742410 DOI: 10.1007/s100249910030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The 1993 E. coli O157:H7 epidemic in the Western United States has provided a unique opportunity to evaluate the histopathologic temporal progression of disease in the colon in children who developed hemolytic uremic syndrome (HUS). In this report we briefly summarize the clinical courses of eight patients and then discuss the colonic pathology observed in specimens obtained at surgery or at the time of autopsy. The patients were divided into two groups: group 1 consisted of six subjects whose colonic samples were obtained during the acute phase of disease, and group 2 consisted of two subjects whose samples were obtained late in their disease. Both the gross and microscopic findings showed that the most severely affected as well as the earliest affected regions of the colon were the left and transverse portions. Only later in the disease progression was there right-sided colon involvement. These findings are in contrast to the distribution described in E. coli O157:H7 hemorrhagic colitis without HUS, thus suggesting a different mechanism of injury.
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Affiliation(s)
- K F Murray
- Department of Pediatrics, Division of Gastroenterology, Children's Hospital and Regional Medical Center, Seattle, WA 98105-0371, USA
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Abstract
A 13 year old girl is reported who presented with haemolytic uraemic syndrome (HUS) due to Escherichia coli O157:H7 infection. She died during the acute phase of the illness after an episode of unexplained sudden circulatory collapse. Postmortem examination confirmed the diagnosis of HUS and showed histological evidence of myocarditis manifested by the presence of inflammatory cell infiltration in the myocardium and around the conducting system.
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Affiliation(s)
- I Abu-Arafeh
- University of Aberdeen, Department of Child Health, Foresterhill
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Affiliation(s)
- R L Siegler
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
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Abstract
Six children are described who developed diarrhoea associated with Clostridium difficile during the course of haemolytic uraemic syndrome. The significance of this infection is discussed within the context of the pathophysiology of haemolytic uraemic syndrome.
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Affiliation(s)
- D P Burgner
- Department of Medicine, Royal Hospital for Sick Children, Yorkhill, Glasgow
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Dhillon AP, Anthony A, Sim R, Wakefield AJ, Sankey EA, Hudson M, Allison MC, Pounder RE. Mucosal capillary thrombi in rectal biopsies. Histopathology 1992; 21:127-33. [PMID: 1505929 DOI: 10.1111/j.1365-2559.1992.tb00360.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We studied the initial rectal biopsy from 46 patients in whom subsequent follow-up established the diagnosis of either self-limited colitis or inflammatory bowel disease. An additional 12 non-inflamed rectal biopsies were also studied. There was between 2 and 8 years of follow-up in each of these cases. Staining for fibrin (MSB, fibrinogen), platelets (factor XIIIA, Y2/51), and capillary basement membrane (reticulin, collagen 4) was performed to identify thrombotic material within capillaries. Mucosal capillary thrombi were best identified by staining for factor XIIIA; thrombi were observed in 8/13 cases of ulcerative colitis, 4/10 cases of Crohn's disease, 1/3 cases of unspecified inflammatory bowel disease and 5/20 cases of self-limited colitis. The presence of capillary thrombi was not related to the severity of inflammation, but none of the control biopsies showed capillary thrombi. Their presence seems of little diagnostic value in distinguishing inflammatory bowel disease from self-limited colitis. The pathogenetic significance of these mucosal capillary thrombi is uncertain.
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Affiliation(s)
- A P Dhillon
- Department of Histopathology, Royal Free Hospital School of Medicine, London, UK
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Hudson M, Piasecki C, Sankey EA, Sim R, Wakefield AJ, More LJ, Sawyerr AM, Dhillon AP, Pounder RE. A ferret model of acute multifocal gastrointestinal infarction. Gastroenterology 1992; 102:1591-6. [PMID: 1568569 DOI: 10.1016/0016-5085(92)91718-j] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Based on the demonstration of mural granulomatous vasculitis in Crohn's disease, it was hypothesized that this vasculitis may account for the discontinuous pattern of lesions in this condition. Accordingly, the present study investigated the histological changes produced by interruption of the submucosal and mucosal microcirculation in the ferret midgut. Two techniques were used. First, up to 30 adjacent vasa recta were ligated using microsurgical techniques; this produced no evidence of ischemic damage. Second, interruption of the submucosal collateral plexus by the intra-arterial injection of styrene microspheres (27-, 50-, or 90-microns diameter) produced acute intestinal mucosal damage. A combination of 27- and 90-microns spheres resulted in focal mucosal inflammation, necrosis, and ulceration. "Summit" lesions with normal adjacent mucosa were observed 48 hours after embolization, with evidence of regeneration of the mucosa overlying the occluded vessels at 72 hours. This model shows that focal gastrointestinal infarction with normal adjacent mucosa can be produced by acute occlusion of submucosal and mucosal arteries.
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Affiliation(s)
- M Hudson
- University Department of Medicine, Royal Free Hospital School of Medicine, London, England
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