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Related Experiment Videos

Obliterative enteritis complicating graft versus host disease.

G Gavel1, S Marven, M J Evans

  • 1Paediatric Surgical Unit, Sheffield Children's Hospital, Sheffield, UK.

Bone Marrow Transplantation
|November 20, 2003
PubMed
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.

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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.

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  • 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.