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Obliterative enteritis complicating graft versus host disease
1Paediatric Surgical Unit, Sheffield Children's Hospital, Sheffield, UK.
Bone Marrow Transplantation
|November 20, 2003
Summary
A bone marrow transplant recipient with acute lymphoblastic leukemia developed severe gut graft-versus-host disease (GvHD), leading to obliterative enteritis. This extreme GvHD manifestation caused small bowel obstruction, potentially worsened by viral infections.
Area of Science:
- Gastroenterology
- Hematology
- Immunology
Background:
- Bone marrow transplantation is a critical treatment for acute lymphoblastic leukemia.
- Graft-versus-host disease (GvHD) is a common complication following allogeneic bone marrow transplantation.
- Intestinal GvHD can lead to significant gastrointestinal morbidity.
Observation:
- A 10-year-old male with Down's syndrome and acute lymphoblastic leukemia developed acute GvHD post-bone marrow transplant.
- The GvHD progressed to severe small bowel obstruction, characterized by a contracted, solid-appearing small bowel with minimal patency.
- Histological examination revealed extensive necrosis of the small bowel wall layers, leading to lumen obliteration.
Findings:
- The patient presented with an extreme form of GvHD, termed obliterative enteritis, causing complete small bowel obstruction.
- Cytomegalovirus and adenovirus were detected, suggesting a potential role in exacerbating the intestinal GvHD.
- The pathological findings included extensive necrosis and post-inflammatory atrophy of the small bowel.
Implications:
- Obliterative enteritis represents a rare but severe complication of intestinal GvHD.
- Early recognition and management strategies for severe GvHD are crucial.
- The interplay between viral infections and GvHD severity warrants further investigation.