title: Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children.
abstract: Hemorrhagic colitis (HC) is a severe manifestation of the hemolytic uremic syndrome (HUS). We performed a retrospective analysis of patients with HC with the following aims: (1) to characterize the clinicopathologic features; (2) to evaluate mortality rate; (3) to analyze severity of renal and central nervous system (CNS) disease. Patients with HC assisted between 1981-2009 were evaluated and compared with a control group of 137 patients without HC. Among 987 patients with diarrheal prodrome (D) + HUS, 54 (5.5%) presented HC. Clinical findings included abdominal pain (96%), distension (93%), hematochezia (44%), and abdominal mass (11%). Surgery was indicated in 35 patients (65%), and 17 (48.5%) required bowel resection. Transverse and ascending colon were most frequently affected. Macroscopic evaluation showed bowel necrosis (18) and perforation (12). Histologic evaluation (29) showed that 25 (86.2%) had necrosis of the affected segment (transmural in 21). A leukocyte count >20,000/mm(3) and hematocrit >30% were more common in HC patients than in controls (p < 0.001 and p < 0.0001, respectively). Mortality rate was higher in HC patients (33.3%) than in controls (1.4%; p < 0.0001). Dialysis >10 days, seizures, and coma were more frequent in HC patients than in controls (p < 0.0001). In summary, most patients had prominent abdominal findings, and almost 2/3 patients required surgery. Transverse/ascending colon was most affected, and the main histologic finding was transmural necrosis. Higher hematocrit and leukocytosis were frequent. Mortality rate was extremely high, and most had long-lasting anuria and severe neurologic involvement.
authors.affiliation: Department of Nephrology, Hospital de Niños Superiora Sor María Ludovica, 14N° 1631, La Plata, 1900, Argentina. rahman@netverk.com.ar
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Rahman
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Cobeñas
authors.forename: Ricardo
authors.initials: R
authors.lastname: Drut
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Amoreo
authors.forename: Javier D
authors.initials: JD
authors.lastname: Ruscasso
authors.forename: Ana P
authors.initials: AP
authors.lastname: Spizzirri
authors.forename: Angela Del C
authors.initials: Adel C
authors.lastname: Suarez
authors.forename: Javier H
authors.initials: JH
authors.lastname: Zalba
authors.forename: Celia
authors.initials: C
authors.lastname: Ferrari
authors.forename: Marcela C
authors.initials: MC
authors.lastname: Gatti
mesh_terms: D002648:Child; D002675:Child, Preschool; D003092:Colitis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D003967:Diarrhea / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009336:Necrosis; D012189:Retrospective Studies