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Colitis in children with the hemolytic-uremic syndrome
Insights
Hemolytic-uremic syndrome (HUS) can present with gastrointestinal issues like thumbprinting on colon imaging. These findings, though uncommon, suggest HUS in children with bloody diarrhea, guiding diagnostic and surgical decisions.
Area of Science:
- Pediatric Gastroenterology
- Nephrology
- Diagnostic Imaging
Background:
- Hemolytic-uremic syndrome (HUS) is a serious condition characterized by hemolytic anemia, renal failure, and thrombocytopenia.
- Gastrointestinal manifestations are known in HUS, but specific colonic lesions are less commonly emphasized.
Observation:
- Submucosal hemorrhage with "thumbprinting" on barium enema was observed in four patients.
- Rectal prolapse and toxic megacolon were noted in other HUS patients.
- These colonic findings are not typically associated with HUS.
Findings:
- The presence of these colonic lesions in children with bloody diarrhea should raise suspicion for HUS.
- Diagnostic procedures like sigmoidoscopy and barium enema are valuable in assessing colonic involvement in HUS.
Implications:
- Early recognition of these gastrointestinal signs can aid in diagnosing HUS.
- Evaluation of colonic involvement is crucial for determining appropriate management, including potential surgical intervention.
Abstract:
The hemolytic-uremic syndrome consists of hemolytic anemia, renal failure, and thrombocytopenia. Submucosal hemorrhage with "thumbprinting" on roentgenographic examination of the colon with barium was demonstrated in four patients, prolapse of the rectum in two patients, and pseudomembranous enterocolitis and toxic megacolon in one. These lesions are not generally associated with hemolytic-uremic syndrome. The presence of these lesions in a child with bloody diarrhea should suggest hemolytic-uremic syndrome as a possible diagnosis. Sigmoidoscopy and roentgenographic examination of the colon with barium should be done in selected patients with hemolytic-uremic syndrome to evaluate the degree of colonic involvement and the need for surgery.