Smith C D, Schuster S R, Gruppe W E, Vawter G F
J Pediatr Surg. 1978 Dec;13(6D):597-604. doi: 10.1016/s0022-3468(78)80100-6.
The hemolytic-uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. The syndrome can present in dramatic fashion with severe abdominal pain and signs of peritonitis suggesting an acute surgical crisis. In a series of 25 patients, 40% had abdominal pain, 25% had abdominal tenderness, and 20% had peritoneal signs. Clues to diagnosis in the early stages of the acute illness were mild to moderate hypertension, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. Significant abdominal pain and x-ray evidence of colitis may occur before development of typical laboratory findings, and these were evident in at least one case. Three patients underwent laparotomy for suspected bowel perforation. Colitis without perforation was found in all cases. In the absence of documented perforation, toxic megacolon, or intussusception, the decision to perform laparotomy in patients with hemolytic-uremic syndrome who have signs of peritonitis must be individualized. Failure to recognize the underlying renal problem can lead to serious errors in fluid and electrolyte management and delay of appropriate therapy.
溶血尿毒综合征由微血管病性溶血性贫血、急性肾衰竭和在肠胃炎或上呼吸道感染前驱疾病后出现的血小板减少症组成。该综合征可表现为剧烈腹痛和腹膜炎体征，呈现出急性外科急症的显著症状。在一组25例患者中，40%有腹痛，25%有腹部压痛，20%有腹膜体征。急性疾病早期的诊断线索为轻度至中度高血压、外周血涂片异常、尽管脱水仍有贫血以及蛋白尿。典型实验室检查结果出现之前，可能会出现明显的腹痛和结肠炎的X线证据，至少有1例出现了这些情况。3例患者因疑似肠穿孔接受了剖腹手术。所有病例均发现无穿孔的结肠炎。在没有记录到穿孔、中毒性巨结肠或肠套叠的情况下，对于有腹膜炎体征的溶血尿毒综合征患者，决定是否进行剖腹手术必须个体化。未能认识到潜在的肾脏问题可导致液体和电解质管理方面的严重错误以及适当治疗的延迟。
