title: Surgery for acute graft-versus-host disease of the bowel: description of a pediatric case.
abstract: Gastrointestinal acute graft-versus-host disease (GI-aGvHD) is still a common complication of allogeneic stem cell transplantation. Surgical management is an unusual approach, reserved for patients with intestinal occlusion, severe profuse rectal bleeding, or both. The authors describe a child with severe GI-aGvHD who did not respond to common immunosuppressive drugs and procedures and therefore underwent subtotal colectomy due to untreatable rectal bleeding. The bowel resection was followed by three "surgical looks" for occlusive intestinal episodes. In the end, a cholecystectomy for cholelithiasis was performed. The patient is still alive 41 months after stem cell transplantation, and although the terminal ileostomy is not closed yet, his quality of life is good. This experience suggests that surgery can be performed on children with severe, unresponsive GI-aGvHD.
authors.affiliation: Department of Pediatric Hematology/Oncology-Bone Marrow Transplant Unit-Infectious Diseases, G. Gaslini Children's Research Institute, Genova, Italy. maurafaraci@ospedale-gaslini.ge.it
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
authors.forename: Sandro
authors.initials: S
authors.lastname: Dallorso
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Morreale
authors.forename: Giorgio
authors.initials: G
authors.lastname: Dini
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Maurizio
authors.initials: M
authors.lastname: Miano
authors.forename: Monica
authors.initials: M
authors.lastname: Canepa
authors.forename: Antonino
authors.initials: A
authors.lastname: Rizzo
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.forename: Paolo
authors.initials: P
authors.lastname: Gandullia
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiore
authors.forename: Carla
authors.initials: C
authors.lastname: Marino
authors.forename: Luca
authors.initials: L
authors.lastname: Manfredini
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lanino
mesh_terms: D002648:Child; D003082:Colectomy; D006086:Graft vs Host Disease / Q000601:surgery*; D006801:Humans; D007420:Intestine, Large / Q000473:pathology* / Q000601:surgery*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D033581:Stem Cell Transplantation / Q000009:adverse effects*