Surgery for intestinal graft-versus-host disease

Abstract

PURPOSE: With allogeneic bone marrow transplantation becoming increasingly common, intestinal graft-versus-host disease often is seen within specialized transplant units. Surgeons are involved infrequently in the management of such patients, and yet occasionally are called upon to operate on critically ill patients with refractory disease. This article reviews the salient features of this condition and discusses possible indications for surgery. METHOD: Two cases of intestinal graft-versus-host disease that required laparotomy are presented. RESULTS: A 24-year-old male with severe, unremitting, acute intestinal graft-versus-host disease underwent small-bowel and large-bowel resections for massive bleeding. A 35-year-old male with recurrent symptoms of small-bowel obstruction after allogeneic bone marrow transplantation underwent small-bowel resection and multiple strictureplasties for chronic intestinal graft-versus-host disease. CONCLUSION: Surgery can be performed for complications of intestinal graft-versus-host disease not responding to medical therapy, with successful outcome.