Surgical treatment of intestinal complications of graft versus host disease in the pediatric population: Case series and review of literature

Camille A. Gutierrez, Mehul V. Raval, Hannah R. Vester, Sonali Chaudhury, Daniel von Allmen, David H. Rothstein*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

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 6 weeks postoperatively. The median overall follow-up time was 20 months (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.

Original languageEnglish (US)
Pages (from-to)1718-1722
Number of pages5
JournalJournal of Pediatric Surgery
Volume52
Issue number11
DOIs
StatePublished - Nov 1 2017

Keywords

  • GVHD
  • Hemorrhage
  • Intestinal complications
  • Obstruction
  • Pediatric surgery
  • Perforation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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