Transcripts
DR. TARR:
Now, I would like to talk about
chronic abdominal pain syndrome. Over the years
and even before E. coli 0157 became such a
notorious pathogen I would receive phone calls
from practitioners throughout the Pacific
Northwest telling me about a child in their
practice who may have had E. coli infection,
some of those whom had HUS, who had come in with
chronic abdominal pain.
Now, following a severe episode
such as HUS we would be most worried about a
surgically remediable problem. And surgically
remedial problems really are strictures -- it says
structures (points to slide) but it should have
been strictures, my fault -- where there could have been
a post-infectious narrowing in part of
the gastrointestinal tract.
Now, the colon is the most frequently
involved area with strictures, although
the small bowel can sometimes be involved.
Whenever I have heard of a colonic stricture it
has become apparent usually while the
child is still in the hospital getting ready to
go home and they're showing signs suggestive of
strictures. However, such problems almost always
become apparent within 60 days from discharge of
the hospitals.
Small bowel strictures - I've
really only heard of one and I wasn't personally
involved in that case and this became apparent
about a year later. So it can happen I guess,
once you keep an open mind about it you might
find it, but it's a relatively rare event and we
have not seen any since 1993. And during the
1993 outbreak we saw two or three colonic
strictures in about 35 children with hemolytic
uremic syndrome.
Gall stones, however, are
surgically removable and those occurred in about 10
percent of the outbreak as recorded by Dr.
Brandt. We have seen only a handful of children
since then with gallstones following their HUS,
nowhere near the 10 percent rate. We
certainly keep it in mind when a child comes in
with severe abdominal pain, especially if the
severe abdominal pain is in the right upper quadrant
where the liver and gall are located. But
gallstones do exist in this setting, and, it
would be a pity to miss, and it presents late
in children and adults who tend to come back to
us three to twelve months after discharge from
the hospital.
