Skip to main content

Advertisement

SpringerLink
Log in

Beware of hemolytic uremic syndrome presenting as colorectal disease in adults

Report of two cases

  • Case Reports
  • Published:
Diseases of the Colon & Rectum

Abstract

Hemolytic uremic syndrome is seen occasionally by the surgeon in adult patients with colorectal manifestations. Two cases of hemolytic uremic syndrome are presented here, one misdiagnosed clinically as acute appendicitis and the other as acute ulcerative colitis. In each case the diagnosis was only established postoperatively and both patients died of this disease. These cases serve to remind colorectal surgeons that this potentially lethal diseases may occur with symptoms and signs suggestive of more common colorectal pathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Habib R, Mathieu H, Royer P. Le syndrome hemolytique et uremique de l'enfant. Nephron 1967;4:139–72.

    PubMed  CAS  Google Scholar 

  2. Gasser C, Gautier E, Steck A, Siebenmann RE, Oechslin R. Hamolytischurami sches syndrome: Bilaterale Nierenrindennekrosen bei Akuten erworben hamulytischen Anami en. Schweiz Med Wochenschr 1955;85:905–9.

    PubMed  CAS  Google Scholar 

  3. Liebermann E. Hemolytic-uremic syndrome. J Pediatr 1972;80:1–16.

    Article  Google Scholar 

  4. Tune BM, Leavit TJ, Gribble TJ. The haemolytic uraemic syndrome in California: a review of 28 non-heparinized cases with long term follow-up. J Pediatr 1973;82:304–10.

    Article  PubMed  CAS  Google Scholar 

  5. Gianantonio CA, Vitacco M, Mendeleharza F, Gallo GE, Sojo ET. The haemolytic uraemic syndrome. Nephron 1973;11:174–92.

    PubMed  CAS  Google Scholar 

  6. Anonymous (from CDSC). British Paediatric Association, Communicable Disease Surveillance Centre. Surveillance of haemolytic uraemic syndrome 1983–4. Br Med J 1986;292;115–7.

    Google Scholar 

  7. Morel-Maroger L, Kamfar A, Solez K, Sraer JD, Richet G. Prognostic importance of vascular lesions in acute renal failure with micro-angiopathic haemolytic anaemia (haemolytic uraemic syndrome): clinico-pathologic study in 20 adults. Kidney Int 1979;15:548–58.

    PubMed  CAS  Google Scholar 

  8. Taichman NS. The local Shwartzman reaction. In: Moratz HZ, ed. Inflammation, immunity and hypersensitivity. New York: Harper & Row, 1971:479–526.

    Google Scholar 

  9. Evanson S, Hjort A. Pathogenesis of disseminated intravascular coagulation. Plenary Scientific Contributions, XIII International Congress. Munich: Lehmanns, 1970:109–20.

    Google Scholar 

  10. Koster F, Levin J, Walker L, et al. Hemolytic uremic syndrome after shigellosis: relation to endotoxemia and circulating immune complexes. N Engl J Med 1978;298:927–33.

    Article  PubMed  CAS  Google Scholar 

  11. Takeuchi A, Sprintz H, LeBrec EH, Formal SB. Experimental bacillary dysentery: an electron microscopic study of the response of the intestinal mucosa to bacterial invasion. Am J Pathol 1965;47:1011–44.

    PubMed  CAS  Google Scholar 

  12. Karmali MA, Steele JT, Patric M, Lein C. Sporadic cases of haemolytic uraemic syndrome associated with faecal cytotoxin and cytotoxin producingE. coli in stools. Lancet 1983;2:619–20.

    Article  Google Scholar 

  13. Emody L, Kereny M, Batai I, Paesa S, Szekely J, Kelleomayer M. Haemolytic uraemic syndrome and haemolytic E. coli. Lancet 1984;1:1248–9.

    Article  PubMed  CAS  Google Scholar 

  14. Chamonitz BN, Hartstein AI, Alexander SR, et al. Campylobacter jejuni associated haemolytic uraemic syndrome in a mother and daughter. Pediatrics 1983;71:253–6.

    Google Scholar 

  15. Behan WM, Milli PR. Possible evidence for a Shwartzman reaction in pseudomembranous colitis. Digestion 1982;23:141–50.

    PubMed  CAS  Google Scholar 

  16. Takeuchi A, Sprinz H. Electromicroscopic studies of experimental salmonella infection in the preconditioned guinea pig: II. response of the intestinal mucosa to the invasion by Salmonella typhimurium. Am J Pathol 1967;51:137–61.

    CAS  PubMed  Google Scholar 

  17. Mathan MM, Mathan VI. Local Shwartzman reaction in the rectal mucosa in acute diarrhoea. J Pathol 1985;146:179–87.

    Article  PubMed  CAS  Google Scholar 

  18. Whitehead R. Ischaemic enterocolitis, an expression of the intravascular coagulation syndrome. Gut 1971;12:912–7.

    PubMed  CAS  Google Scholar 

  19. Whitehead R. The pathology of intestinal ischemia. Clin Gastroenterol 1972;1:634.

    Google Scholar 

  20. Katz J, Krawitz S, Sacks PV et al. Platelet, erythrocyte and fibrinogen kinetics in the hemolytic uremic syndrome of infancy. J Pediatr 1973;83:739–48.

    Article  PubMed  CAS  Google Scholar 

  21. Harker LA, Slichter SH. Platelet and fibrinogen consumption in man. N Engl J Med 1972;287:999–1005.

    Article  PubMed  CAS  Google Scholar 

  22. Sundsmo JS, Fair DS. Relationship among the complement, kinin, coagulation and fibrinolytic systems in the inflammatory reaction. Clin Physiol Biochem 1983;1:225–84.

    PubMed  CAS  Google Scholar 

  23. Gervais M, Richardson JB, Chin J, Drummond KN. Immunofluorescent and histologic findings in the haemolytic uraemic syndrome. Pediatrics 1971;47:352–8.

    PubMed  CAS  Google Scholar 

  24. Webster J, Rees AJ, Lewis PJ, Hensby CN. Prostacyclin deficiency in haemolytic uraemic syndrome. Br Med J 1980;281:271.

    PubMed  CAS  Google Scholar 

  25. Hensby CN, Fitzgerald GA, Friedman LA, Lewis PJ, Dollary CT. Measurement of 6-oxo-PGF1 in human plasma using gas chromatography-mass spectrometry. Prostaglandins 1979;18:731–6.

    Article  PubMed  CAS  Google Scholar 

  26. Farr MJ, Roberts S, Morley AR, Dewar PJ, Roberts DF, Uldall PR. The haemolytic uraemic syndrome—a familial study. Q J Med 1975;44:161–88.

    PubMed  CAS  Google Scholar 

  27. Berman W. The haemolytic uraemic syndrome: initial clinical presentation mimicking ulcerative colitis. J Pediatr 1972;81:275–8.

    Article  PubMed  Google Scholar 

  28. Dillard EP. Hemolytic uremic syndrome mimicking ulcerative colitis. Clin Pediatr (Phila) 1983;22:66–7.

    Article  CAS  Google Scholar 

  29. Craner DE, Burdick GE. Acute colitis resembling ulcerative colitis in the hemolytic uremic syndrome. Dig Dis 1976;21:74–6.

    Article  CAS  Google Scholar 

  30. White DJ, Yong F, McKendrick MW. Haemolytic syndrome in adults. Br Med J 1988;296:899.

    CAS  Google Scholar 

  31. Wittington PF, Friedman AL, Chesney RW. Gastrointestinal disease in the hemolytic uremic syndrome. Gastroenterology 1979;76:728–33.

    Google Scholar 

  32. Peterson RB, Muscroll WP, Shrago GG, et al. Radiographic features of colitis associated with hemolytic uremic syndrome. Radiology 1976;180:667–71.

    Google Scholar 

  33. Vitacco M, Avelos JS, Gianantonio CA. Heparin therapy in hemolytic uremic syndrome. J Pediatr 1973;83:271–5.

    PubMed  CAS  Google Scholar 

  34. Thorson CA, Rossi EC, Green D, Carone FA. The treatment of the hemolytic uremic syndrome with inhibitors of platelet function. Am J Med 1979;66:711–6.

    Article  Google Scholar 

  35. Luke RG. Treatment of acute hemolytic uremic syndrome. N Engl J Med 1976;294:396–9.

    PubMed  CAS  Google Scholar 

  36. Stuart J, Winterborn MH, White RM. Thrombocytic therapy in haemolytic uraemic syndrome. Br Med J 1974;3:217–25.

    PubMed  CAS  Google Scholar 

  37. Misiani R, Appiani AC, Edefonti A, et al. Haemolytic uraemic syndrome: therapeutic effects of plasma infusion. Br Med J 1982;285:1304–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, The General Hospital, Birmingham, UK

    Arthur Allan M.D., M. R. B. Keighley M.S. & Henry Thompson M.D.

Authors
  1. Arthur Allan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. R. B. Keighley M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry Thompson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Allan, A., Keighley, M.R.B. & Thompson, H. Beware of hemolytic uremic syndrome presenting as colorectal disease in adults. Dis Colon Rectum 32, 426–428 (1989). https://doi.org/10.1007/BF02563697

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02563697

Key words

Search

Navigation