Hemolytic-Uremic Syndrome Confused With Acute Appendicitis

Edmonson, M. Bruce

doi:10.1001/archsurg.1978.01370180096017

Cited by 16 publications

(6 citation statements)

References 9 publications

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“…Abdominal features may sometimes appear prior to the detection of characteristic HUS findings, which may lead to misdiagnosis, such as ulcerative colitis or acute surgical abdomen (e.g., acute appendicitis or intestinal intussusception) [16][17][18]. Abdominal pain and distention were the most frequent clinical findings, and hematochezia was present in almost half of the patients in our series.…”

Section: Resultsmentioning

confidence: 79%

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

et al. 2011

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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.

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Section: Resultsmentioning

confidence: 79%

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

et al. 2011

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“…Due to our patient's positive ultrasound findings for acute appendicitis, we were faced with a diagnostic dilemma to differentiate primary appendicitis from secondary appendicitis due to HUS. A literature review highlights a case from 1978 where the diagnosis of HUS was confused with acute appendicitis (2), which eventually resulted in However, as a 1991 study suggests, appendectomies in these situations of diagnostic confusion may not yield typical results; in four cases where unnecessary appendectomy was performed, the operative findings were not typical of primary acute appendicitis, although two of these cases did have histological evidence of inflammation of the appendix (4). The study did not comment on imaging prior to appendectomy but did report that these patients did not have typical symptoms of appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Evidence of Acute Appendicitis in a Patient with Hemolytic Uremic Syndrome

Siddiqui

Nadeem

Menon

et al. 2019

Journal of Emergency Medicine Case Reports

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Introduction:Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Children with HUS often present with gastrointestinal complaints, including abdominal pain, vomiting, and diarrhea. This presentation can mimic other gastrointestinal illnesses, including appendicitis, which further adds to the known diagnostic challenge. Case Report:We report an 8-year-old male who presents with abdominal pain and diarrheaassociated HUS. Kidney ultrasound obtained for acute kidney failure showed an incidental finding of a dilated appendix which was confirmed on a follow-up appendix ultrasound. Patient lacked the typical findings of acute appendicitis such as fever, abdominal tenderness or rigidity. We observed the patient without medical or surgical treatment for acute appendicitis as ultrasound findings were attributed to HUS, and the patient's abdominal pain and HUS resolved without any intervention. Conclusion:Self-limited appendiceal inflammation may be seen in diarrhea-associated HUS, and the diagnostic utility of appendix ultrasound to evaluate for acute appendicitis may be limited in a patient with HUS and abdominal pain.

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“…The abdominal pain associated with HUS is often severe and frequently mimics an acute surgical abdomen [4][5][6][7]. Cimolai et al [4] found that surgical services are asked to evaluate abdominal pain in 20% of children with infectious colitis from E. coli O157:H7.…”

Section: Discussionmentioning

confidence: 99%

Acute appendicitis in a patient with hemolytic uremic syndrome: an unusual clinical scenario

et al. 2007

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Gastroenteritis due to Escherichia coli O157:H7 occurs in young children and is associated with consumption of under cooked beef. Approximately 5-10% of patients will develop hemolytic uremic syndrome (HUS): renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. A 6-year-old boy was admitted with abdominal pain, guaiac positive stool, decreased urine output and elevated creatinine levels. Hemodialysis was initiated upon rapid progression to anuria. On hospital day # 5 he developed acute abdominal pain, which was different from his initial assessment. Exam revealed focal tenderness in the right lower quadrant with localized guarding and rebound. Ultrasound demonstrated a dilated, fluid filled tubular structure in the RLQ concerning for appendicitis. Based on these findings the patient was taken to the operating room for a laparoscopic appendectomy. The patient had undergone dialysis the previous day and was preoperatively treated with DDAVP to minimize the risk of bleeding. The procedure occurred without complication and final pathology confirmed acute appendicitis. This case highlights the unique clinical scenario in which patients with HUS require operative intervention. Surgical procedures can be performed on these patients, however, all precautions should be taken to minimize the risk of bleeding, including the use of preoperative DDAVP.

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Hemolytic-Uremic Syndrome Confused With Acute Appendicitis

Cited by 16 publications

References 9 publications

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

Ultrasound Evidence of Acute Appendicitis in a Patient with Hemolytic Uremic Syndrome

Acute appendicitis in a patient with hemolytic uremic syndrome: an unusual clinical scenario

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