TIMING OF COLONIC NECROSIS IN HEMOLYTIC-UREMIC SYNDROME

Hemolytic uremic syndrome (HUS) consists of an acute onset of microang lopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. HU S-associated colitis can be seen in up to 100% of patients and is usua lly associated with severe abdominal pain and distention. Colonic perf oration is a complication of HUS that has a reported incidence of 1%-2 %, and although there are several case reports in the literature descr ibing perforation of the colon, it is still very difficult to discern the abdominal symptoms associated with HUS colitis from perforation. F our cases of colonic perforation are reported here from a consecutive series of 57 patients, in which a trend in the length of time from the onset of symptoms of HUS to colonic perforation was determined. A rev iew of the literature for cases of HUS-associated colonic perforation was also performed. The time from the onset of HUS symptoms to colonic perforation in our series was similar to that found in the literature review (11 +/- 5 vs 14 +/- 8 days). Awareness that this complication has a tendency to occur towards the end of the 2nd week during the cou rse of HUS is essential to avoid an unnecessary and untimely surgical intervention.