Transcripts
DR. TARR:
During HUS we've seen some
unusual complications. Vomiting is very common
into the early part of the illness. I have
seen a few people, adults as I recall, vomit
blood. And on endoscopy, I have heard, although
not seen this, that the stomach is raw and
appears like hamburger. Presumably it's a form
of hemorrhagic gastritis.
Biopsies were not obtained, so I
don't know the pathology underlying it. It's a
rather unusual complication.
In the small bowel one can see
necrotic areas, actual perforations. And in the
colon one can see the same lesions, also
necrosis and perforations.
Our surgeons looked at the
experience from the tragic 1993 outbreak and
looked back and said what was it that made them
go to the operating room in retrospect because
almost all of these children have tender abdomens
and predominant gastrointestinal syndrome. They
then asked what it was that really made them go
to the operating room.
And they came up with an
interesting observation that acidosis, the sudden
inability of the body to handle the acids that
are normally made during the metabolic processes,
suggested that there was something going on
within the abdomen requiring a surgical remedy.
We have not had any surgical
complications, except for one child with an
intussception, since 1993 in children with HUS,
but it is relatively common for us to request a
surgeon follow such children.
Not so much recently, but
through the early 1990's, approximately 10
percent of the children in our hospital year
after year who developed Hemolytic Uremic
Syndrome were admitted to the medical service via
surgical service.
Their primary care doctor
referred them to a surgeon who followed them
over a couple of days, and then saw the blood
count drop, and then transferred their care to a
nephrologist. So it's not unusual for a surgeon
to be involved and it can be quite appropriate.
And we are focusing some of our
education efforts on surgeons as to how to
recognize this and how to treat it.
