Beware of hemolytic uremic syndrome presenting as colorectal disease in adults

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 disease may occur with symptoms and signs suggestive of more common colorectal pathology.

Ulcerative Colitis and Thrombotic Thrombocytopenic Purpura

“…Hemolytic-uremic syndrome and TTP have been reported to mimic UC and other colorectal diseases in both children and adults. 11,12 The pathologic examination in these cases revealed occlusion of submucosal arterioles by recent and organizing thrombi. 11 Although we did not test for Shiga Toxin or for deficiency of von Willebrand factor-cleaving protease activity, we think that our patient developed TTP secondary to exacerbation of UC.…”

Devastating Presentations of Regional Enteritis (Crohn's Disease): Two Reports of Survival Following Severe Multiple Organ Dysfunction Syndrome

“…The intravascular hemolysis of C. perfringens sepsis is produced by alpha toxin, a phospholipase C lecithinase. Alpha toxin is capable of lysing erythrocytes, platelets, leukocytes, endothelial cells, and exhibiting hepatic mitochondrial toxicity, thereby causing massive hemolysis, increased vascular permeability, tissue disruption, and hepatotoxicity [18].…”