Surgery for acute graft-versus-host disease of the bowel: description of a pediatric case.
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.
Faraci
Maura
M
Department of Pediatric Hematology/Oncology-Bone Marrow Transplant Unit-Infectious Diseases, G. Gaslini Children's Research Institute, Genova, Italy. maurafaraci@ospedale-gaslini.ge.it
Dallorso
Sandro
S
Morreale
Guiseppe
G
Dini
Giorgio
G
Castagnola
Elio
E
Miano
Maurizio
M
Canepa
Monica
M
Rizzo
Antonino
A
Mattioli
Girolamo
G
Gandullia
Paolo
P
Fiore
Paolo
P
Marino
Carla
C
Manfredini
Luca
L
Lanino
Edoardo
E
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*