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

Pediatr Nephrol. 2012 Feb;27(2):229-33. doi: 10.1007/s00467-011-1973-z. Epub 2011 Aug 2.


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.

MeSH terms

  • Child
  • Child, Preschool
  • Colitis / etiology*
  • Colitis / mortality
  • Colitis / pathology
  • Diarrhea / complications*
  • Female
  • Gastrointestinal Hemorrhage / etiology*
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / pathology
  • Hemolytic-Uremic Syndrome / complications*
  • Humans
  • Infant
  • Male
  • Necrosis
  • Retrospective Studies