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Small bowel stenosis: a manifestation of chronic graft-versus-host disease in children?

Mickael Tordjman1, Marie Ouachee2, Arnaud Bonnard3

  • 1Pathology Department, Robert Debré Hospital, APHP, 75019, Paris, France.

Human Pathology
|September 14, 2017
PubMed

Insights

Small bowel obstruction is a rare complication of bone marrow transplants, even in children. This study details 4 pediatric cases, highlighting surgical outcomes for this severe gastrointestinal complication.

Area of Science:

  • Gastroenterology
  • Pediatric Hematology/Oncology
  • Transplantation Immunology

Background:

  • Digestive graft-versus-host disease (GVHD) is a common complication following bone marrow transplantation.
  • Small bowel obstruction is an exceptionally rare manifestation of digestive GVHD.

Observation:

  • This study presents the first pediatric series of 4 cases experiencing small bowel obstruction post-bone marrow transplantation.
  • Patients presented with abdominal pain and small bowel occlusion 5-16 months after transplantation, with CT scans showing multiple intestinal stenoses.
  • Histological analysis of resected ileal specimens revealed features of both acute and chronic GVHD, including crypt apoptosis, submucosal fibrosis, and ulcerations.

Findings:

  • Severe acute GVHD treated with immunosuppressants and/or infliximab preceded the obstruction in all cases.
  • NOD2 gene mutation was identified in only one patient.
  • Surgical resection of affected intestinal loops resulted in successful outcomes for all patients.

Implications:

  • This case series expands the understanding of rare gastrointestinal complications following bone marrow transplantation in pediatric patients.
  • Early surgical intervention may be crucial for managing severe small bowel obstruction secondary to GVHD.
  • Further research into the pathogenesis and genetic factors, such as NOD2 mutations, may refine treatment strategies for GVHD-related intestinal complications.

Keywords:
ChildrenGraft-versus-host diseaseNOD2Small bowel stenosisSurgery

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