Beyond gastrointestinal graft-versus-host disease. A lesson to learn.
The authors present a child with severe GvHD of GI tract with typical presentation of ileus and abdominal pain. However, the severe GvHD has led to multiple intermittent intussusceptions with resultant ischemic segments of the small bowel leading to sub-acute mechanical intestinal obstruction. The clinical presentation of the mechanical intestinal obstruction was identical to the preceding ileus GvHD presentation. This has led to continuation of the conservative management with immunosuppressant therapy and delaying further investigation and surgical intervention. Once a barium study demonstrated the severe bowel constriction, laparoscopic surgical resection was necessary with excellent results. The resected small bowel showed multiple segments of ischemic ileitis leading to ulceration and severe stricture. The resection margins showed regenerating mucosa with no ulceration, but with focal evidence of mild GvHD.
Gassas
Adam
A
Division of Haematology/Oncology/Blood and Marrow Transplantation Program, Hospital for Sick Children, University of Toronto, Ontario, Canada. adam.gassas@sickkids.ca
Zaidman
Irina
I
Schechter
Tal
T
Doyle
John
J
D001464:Barium / Q000494:pharmacology; D002648:Child; D006086:Graft vs Host Disease / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007082:Ileum / Q000473:pathology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007415:Intestinal Obstruction / Q000276:immunology / Q000601:surgery*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D010535:Laparoscopy / Q000379:methods; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011859:Radiography; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D001464:Barium