Adv Pediatr Surg.  2019 Jun;25(1):29-34. 10.13029/aps.2019.25.1.29.

A Case of Hemolytic Uremic Syndrome after Appendectomy

• Kim L
• Jung HL
• Shim JY
• Kim DS
• Shim JW
• Han YJ
• Kwak JH

• KMID: 2451066
• DOI: http://doi.org/10.13029/aps.2019.25.1.29

Abstract

Hemolytic uremic syndrome (HUS) is associated with consumption of under cooked gound beef, characterized by triad of renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Early recognition of this disease, maintenance of fluid balance and proper dialysis seems to prevent acute mortality. A 23-month-old boy was admitted with abdominal pain, bloody diarrhea and fever. On hospital day (HD) #2, he developed aggravated abdominal pain compared to the initial assessment. Contrast abdominal computed tomography demonstrated findings suggestive acute appendicitis so the patient was underwent laparoscopic appendectomy. On HD #3 and #4, his laboratory findings showed marked thrombocytopenia and serum creatinine elevation. He was transferred to another hospital for dialysis with the impression of acute renal failure. Later, verotoxin-producing Escherichia coli, which is one of the most common causes of HUS, was detected on his initial stool examination. HUS can present with prodromal gastrointestinal symptoms mimicking acute abdomen. So even if the patient is primarily diagnosed acute abdomen in the initial setting, clinicians should always keep in mind of other fatal conditions disease, such as HUS. To our knowledge, this is the first case report of acute appendicitis followed by HUS in South Korea.

Keyword

Hemolytic uremic syndrome; Appendicitis; Acute renal failure; Verotoxin-producing Escherichia coli

MeSH Terms

Abdomen, Acute
Abdominal Pain
Acute Kidney Injury
Anemia, Hemolytic
Appendectomy*
Appendicitis
Creatinine
Dialysis
Diarrhea
Fever
Hemolytic-Uremic Syndrome*
Humans
Infant
Korea
Male
Mortality
Red Meat
Renal Insufficiency
Shiga-Toxigenic Escherichia coli
Thrombocytopenia
Water-Electrolyte Balance
Creatinine

Figure

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  Fig. 1 Simple abdomen radiograph (flat) at the admission.

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  Fig. 2 Wall thickening with 6 mm of dilatation of appendix was observed on bowel sonography.

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  Fig. 3 Enhancing wall thickening and fluid filled dilatation of appendix on abdominal-pelvis computed tomography.

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  Fig. 4 Histologic examination shows telangiectasia of the serosa and the lumen contains suppurative exudate. (A) H&E, ×40; (B) H&E, ×400. H&E, hematoxylin and eosin.

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  Fig. 5 Laboratory findings during HD #1 to #18. He undertaken appendectomy on HD #2, and transferred to another hospital for hemodialysis on HD #4. After daily hemodialysis for 5 days, his urine output, fever, and abdominal pain were improved. The abnormal laboratory findings were recovered until discharge on HD #18. HD, hospital day; Hb, hemoglobin; PLT, platelet; Cr, creatinine; AST, aspartate transaminase; ALT, alanine aminotransferase.

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