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Boulkroun H, Lacotte E, Angoso M, Dalle JH, Kallout J, Nolla M, Picard A, Paillard C, Plantaz D, Renard C, Rialland F, Schneider P, Buchbinder N. Late stenosis of the small intestine and colon, an atypical feature of chronic graft-versus-host disease. National retrospective study in French pediatric allograft centers. Bone Marrow Transplant 2024; 59:1316-1319. [PMID: 38886485 DOI: 10.1038/s41409-024-02330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 05/08/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Hana Boulkroun
- Pediatrics, Hospital Charles Nicolle CHU Rouen, Rouen, France.
| | - Edouard Lacotte
- Pediatric Gastro-Enterology CHU Caen Normandie, Caen, France
| | - Marie Angoso
- Pediatric Hematology Oncology, Center Pellingrin, CHU Bordeaux, Bordeaux, France
| | - Jean Hugues Dalle
- Pediatric Hematology Oncology and Stem Cells Transplantation, Robert Debré Hospital Paris,GH APHP-Nord, Paris University, Paris, France
| | | | - Marie Nolla
- Pediatric Hematology Oncology, CHU Toulouse, Toulouse, France
| | - Agathe Picard
- Pediatric Hematology, Oncology, Rennes South Hospital CHU, Rennes, France
| | - Catherine Paillard
- Pediatric Hematology, Oncology, Hospital Hautepierre CHU Strasbourg, Strasbourg, France
| | | | - Cécile Renard
- Pediatric Hematology, Oncology, Center Leon Berard Lyon, Lyon, France
| | - Fanny Rialland
- Pediatric Hematology, Immunology, Oncology, CHU Nantes, Nantes, France
| | - Pascale Schneider
- Pediatric Hematology, Immunology, Oncology and Stem Cells Transplantation, Rouen University Hospital Charles Nicolle CHU Rouen, Rouen, France
| | - Nimrod Buchbinder
- Pediatric Hematology, Immunology, Oncology and Stem Cells Transplantation, Rouen University Hospital Charles Nicolle CHU Rouen, Rouen, France
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Brogna B, Frieri C, Risitiano AM, Urciuoli L, Storti G, Santoro L, Urciuoli E, De Chiara G, Cretella P, Sementa C, Musto LA, Maccioni F. Intestinal and Extraintestinal Findings of Graft-versus-Host Disease on CT: A Case Series with Radiological and Histopathological Correlations. Biomedicines 2024; 12:1516. [PMID: 39062089 PMCID: PMC11275234 DOI: 10.3390/biomedicines12071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Graft-versus-host disease (GVHD) is an expected and relatively common complication after allogeneic hematopoietic stem cell transplantation. It may affect different organs and typically involves the skin, liver, and gastrointestinal tract (GI-GVHD). GI-GVHD may show heterogeneous presentations with peculiar diagnostic implications. Although an endoscopic biopsy is considered the "gold standard" for the diagnosis of GI-GVHD, its broad application is limited due to the poor clinical conditions usually present in these patients, including thrombocytopenia. In the emergency department, enhanced computed tomography (CECT) has emerged as the best imaging modality for the evaluation of GI damage in frail patients. However, the role of CT in the context of either acute or chronic GI-GVHD has not been systematically investigated. Herein, we focus on the radiological features found on CECT in five patients with GI-GVHD confirmed on histology. CECT was performed for the persistence of GI symptoms in three cases (case 1, case 3, and case 4), for small bowel occlusion in one case (case 5), and for acute GI symptoms in one case (case 2). Serpiginous intestinal wall appearance with multisegmental parietal thickness and homogeneous, mucosal, or stratified small bowel enhancement were common features. Colic involvement with segmental or diffuse parietal thickness was also present. One patient (case 5) presented with inflammatory jejunal multisegmental stenosis with sub-occlusion as a chronic presentation of GI-GVHD. Regarding mesenterial findings, all five patients presented comb signs in the absence of lymphadenopathy. Extraintestinal findings included biliary tract dilatation in two cases (case 2 and case 4). These data support the utility of appropriate radiological investigation in GI-GVHD, paving the way for further serial and systematic investigations to track the appearance and evolution of GI damage in GVHD patients.
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Affiliation(s)
- Barbara Brogna
- Unit Interventional and Emergency Radiology, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (L.U.); (L.A.M.)
| | - Camilla Frieri
- Hematology and Bone Marrow Transplant Unit, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (C.F.); (A.M.R.); (G.S.); (L.S.); (E.U.)
| | - Antonio Maria Risitiano
- Hematology and Bone Marrow Transplant Unit, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (C.F.); (A.M.R.); (G.S.); (L.S.); (E.U.)
| | - Luigi Urciuoli
- Unit Interventional and Emergency Radiology, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (L.U.); (L.A.M.)
| | - Gabriella Storti
- Hematology and Bone Marrow Transplant Unit, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (C.F.); (A.M.R.); (G.S.); (L.S.); (E.U.)
| | - Lidia Santoro
- Hematology and Bone Marrow Transplant Unit, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (C.F.); (A.M.R.); (G.S.); (L.S.); (E.U.)
| | - Eleonora Urciuoli
- Hematology and Bone Marrow Transplant Unit, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (C.F.); (A.M.R.); (G.S.); (L.S.); (E.U.)
| | - Giovanni De Chiara
- Division of Pathologic Anatomy, AORN San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (G.D.C.); (P.C.)
| | - Pasquale Cretella
- Division of Pathologic Anatomy, AORN San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (G.D.C.); (P.C.)
| | - Carmen Sementa
- Forensic Medicine Unit, AORN San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy;
| | - Lanfranco Aquilino Musto
- Unit Interventional and Emergency Radiology, AORN, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy; (L.U.); (L.A.M.)
| | - Francesca Maccioni
- Department of Radiological, Oncological and Pathological Science, Umberto I Hospital, La Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy;
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Wang Y, Liu J, Jiang B, Yuan C, Chen L, Zhang T, Lv Z. Graft-versus-host disease complicated with small bowel obstruction in children: A case report. Front Oncol 2022; 12:1002333. [PMID: 36158644 PMCID: PMC9492891 DOI: 10.3389/fonc.2022.1002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Graft-versus-host disease (GvHD) is a severe complication following hematopoietic cell transplantation (HCT). The clinical manifestations of GvHD can affect multiple systems. Although gastrointestinal (GI) GvHD is common, GI obstruction complications are rare. Here, we present a case of GI-GvHD after HCT for acute myeloid leukemia (AML) in a young girl from China. The patient suffered from watery diarrhea, which progressed to bloody diarrhea 40 days after HCT. She experienced prolonged and repeated mucous or bloody stool after the withdrawal of cyclosporine and the gradual reduction in methylprednisolone. The plain abdominal radiography and computed tomographic (CT) scan showed apparent bowel wall thickening and intestinal stenosis 10 months after HCT. Finally, the patient underwent surgery to remove the small intestinal stenosis at the age of 26 months. The patient recovered with the help of appropriate medical therapies and nutritional support during hospitalization. She remained stable, and there was no recurrence of GI symptoms 16 months after the surgery. In summary, surgery may be an optimal treatment for GvHD patients with persistent bowel obstruction and failure of appropriate immunosuppressive therapies.
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Affiliation(s)
- Yizhong Wang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Gut Microbiota and Metabolic Research Center, Institute of Pediatric Infection, Immunity and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangbin Liu
- Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bingxin Jiang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chenling Yuan
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Licai Chen
- Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Zhang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Gut Microbiota and Metabolic Research Center, Institute of Pediatric Infection, Immunity and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Ting Zhang, ; Zhibao Lv,
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Ting Zhang, ; Zhibao Lv,
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Sukri L, DiChiacchio L, Wasicek PJ, Kavic SM. Small bowel necrosis and perforation due to sodium polystyrene sulfonate in the setting of graft versus host disease and fulminant Clostridium difficile infection. J Surg Case Rep 2020; 2020:rjaa253. [PMID: 32874541 PMCID: PMC7449548 DOI: 10.1093/jscr/rjaa253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023] Open
Abstract
Gastrointestinal injury is a common adverse event associated with use of sodium polystyrene sulfonate (SPS), tradename Kayexalate. Risk factors for SPS-mediated gastrointestinal necrosis include chronic kidney disease, solid organ transplant recipiency and recent surgery. This report presents a patient with past medical history significant for acute myeloid leukemia (AML) complicated by graft versus host disease (GvHD) and Clostridium difficile colitis who initially presented with small bowel obstruction. She was taken to the operating room and her small bowel pathology was significant for transmural necrosis with SPS crystals in the granulation tissue, despite last receiving SPS over a year ago. Previous mucosal damage should be considered as a risk factor for SPS-mediated injury and the effects of this medication may occur longer than previously thought.
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Affiliation(s)
- Leah Sukri
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura DiChiacchio
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Philip J Wasicek
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, MD, USA
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Tordjman M, Ouachee M, Bonnard A, Tilea B, Yakouben K, Viala J, Peuchmaur M, Berrebi D. Small bowel stenosis: a manifestation of chronic graft-versus-host disease in children? Hum Pathol 2018; 72:174-179. [DOI: 10.1016/j.humpath.2017.08.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 02/07/2023]
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Gutierrez CA, Raval MV, Vester HR, Chaudhury S, von Allmen D, Rothstein DH. Surgical treatment of intestinal complications of graft versus host disease in the pediatric population: Case series and review of literature. J Pediatr Surg 2017; 52:1718-1722. [PMID: 28711168 DOI: 10.1016/j.jpedsurg.2017.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND/PURPOSE Intestinal complications of acute graft-versus-host disease (aGVHD) include hemorrhage and perforation in the short-term, and stricture with bowel obstruction in the long-term. As medical management of severe aGVHD has improved, more patients are surviving even advanced stages of intestinal aGVHD. This review summarizes the available pediatric literature on surgical treatment of complications of intestinal GVHD. METHODS A systematic review was performed using PubMed, Cochrane, Embase, and Scopus databases. Any publication that addressed surgical treatment of acute and chronic intestinal GVHD in the pediatric population was reviewed in detail. Furthermore, we included information on 5 additional patients from the institutions of this review's authors, which had not been previously published. RESULTS We identified 8 studies, comprising 13 patients. Surgical interventions were undertaken for a variety of intestinal GVHD complications, including small bowel obstruction owing to stricture (n=8), enterocutaneous fistulae (n=2), gastrointestinal hemorrhage/perforation (n=1 each), and esophageal stricture (n=1). Among eight patients with bowel obstruction as an indication, pathology revealed ulceration with fibrosis in all but one; 3 had signs of persistent GVHD. Surgical mortality was reported in 4 patients (31%) at an average of 6weeks postoperatively. The median overall follow-up time was 20months (IQR, 2-21). CONCLUSIONS Although intestinal aGVHD management is almost exclusively medical, a small subset of patients develops complications of intestinal GVHD that require surgical intervention. With expanding indications for stem cell transplantation as well as improved survival after previously fatal bouts of intestinal aGVHD, it is likely that surgical intervention will become more common in these complicated patients. SYSTEMATIC REVIEW Level of Evidence: Level IV.
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Affiliation(s)
- Camille A Gutierrez
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Hannah R Vester
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sonali Chaudhury
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago
| | - Daniel von Allmen
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David H Rothstein
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY.
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