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Emergencies in Patients with Bone Marrow Transplant

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Surgical Emergencies in the Cancer Patient

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Abstract

Hematopoietic stem cell transplant (HCT) is the transplant of multipotent stem cells derived from bone marrow, peripheral blood, or umbilical cord blood. The transplant may be autologous or allogenic. The severe immunosuppression predisposes patients to many possible life-threatening complications. Although the majority of the complications are treated medically, these patients can become quite ill and develop a need for prompt surgical intervention. Perioperative mortality can be as high as 45 % (Am J Surg 185:481–484, 2003). This chapter reviews the surgical issues for patients undergoing HCT.

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References

  1. Jones AD, Maziarz R, Gilster J, Domreis J, Deveney CW, Sheppard BC. Surgical complications of bone marrow transplantation. Am J Surg. 2003;185(5):481–4.

    Article  PubMed  Google Scholar 

  2. Gorschluter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IG, Sauerbruch T, Glasmacher A. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13. doi:10.1111/j.1600-0609.2005.00442.x.

    Article  PubMed  Google Scholar 

  3. Gil L, Poplawski D, Mol A, Nowicki A, Schneider A, Komarnicki M. Neutropenic enterocolitis after high-dose chemotherapy and autologous stem cell transplantation: incidence, risk factors, and outcome. Transpl Infect Dis. 2013;15(1):1–7. doi:10.1111/j.1399-3062.2012.00777.x.

    Article  CAS  PubMed  Google Scholar 

  4. Nesher L, Rolston KV. Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. Clin Infect Dis. 2013;56(5):711–7. doi:10.1093/cid/cis998.

    Article  PubMed  Google Scholar 

  5. Quigley MM, Bethel K, Nowacki M, Millard F, Sharpe R. Neutropenic enterocolitis: a rare presenting complication of acute leukemia. Am J Hematol. 2001;66(3):213–9.

    Article  CAS  PubMed  Google Scholar 

  6. Alt B, Glass NR, Sollinger H. Neutropenic enterocolitis in adults. Review of the literature and assessment of surgical intervention. Am J Surg. 1985;149(3):405–8.

    Article  CAS  PubMed  Google Scholar 

  7. Bavaro MF. Neutropenic enterocolitis. Curr Gastroenterol Rep. 2002;4(4):297–301.

    Article  PubMed  Google Scholar 

  8. Vehreschild MJ, Weitershagen D, Biehl LM, Tacke D, Waldschmidt D, Tox U, Wisplinghoff H, Bergwelt-Baildon MV, Cornely OA, Vehreschild JJ. Clostridium difficile infection in patients with acute myelogenous leukemia and in patients undergoing allogeneic stem cell transplantation: epidemiology and risk factor analysis. Biol Blood Marrow Transplant. 2014;20(6):823–8. doi:10.1016/j.bbmt.2014.02.022.

    Article  PubMed  Google Scholar 

  9. Machado NO. Neutropenic enterocolitis: a continuing medical and surgical challenge. N Am J Med Sci. 2010;2(7):293–300.

    PubMed  PubMed Central  Google Scholar 

  10. Williams N, Scott AD. Neutropenic colitis: a continuing surgical challenge. Br J Surg. 1997;84(9):1200–5.

    Article  CAS  PubMed  Google Scholar 

  11. Sachak T, Arnold MA, Naini BV, Graham RP, Shah SS, Cruise M, Park JY, Clark L, Lamps L, Frankel WL, Theodoropoulos N, Arnold CA. Neutropenic enterocolitis: new insights into a deadly entity. Am J Surg Pathol. 2015;39(12):1635–42. doi:10.1097/PAS.0000000000000517.

    Article  PubMed  Google Scholar 

  12. Vas WG, Seelig R, Mahanta B, Patel B, Salimi Z, Markivee C, Sundaram M. Neutropenic colitis: evaluation with computed tomography. J Comput Tomogr. 1988;12(3):211–5.

    Article  CAS  PubMed  Google Scholar 

  13. Vogel MN, Goeppert B, Maksimovic O, Brodoefel H, Faul C, Claussen CD, Horger M. CT features of neutropenic enterocolitis in adult patients with hematological diseases undergoing chemotherapy. Rofo. 2010;182(12):1076–81. doi:10.1055/s-0029-1245815.

    Article  CAS  PubMed  Google Scholar 

  14. Moir CR, Scudamore CH, Benny WB. Typhlitis: selective surgical management. Am J Surg. 1986;151(5):563–6.

    Article  CAS  PubMed  Google Scholar 

  15. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet. 2009;373(9674):1550–61. doi:10.1016/S0140-6736(09)60237-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Martin PJ, Schoch G, Fisher L, Byers V, Anasetti C, Appelbaum FR, Beatty PG, Doney K, McDonald GB, Sanders JE, et al. A retrospective analysis of therapy for acute graft-versus-host disease: initial treatment. Blood. 1990;76(8):1464–72.

    CAS  PubMed  Google Scholar 

  17. Vogelsang GB, Lee L, Bensen-Kennedy DM. Pathogenesis and treatment of graft-versus-host disease after bone marrow transplant. Annu Rev Med. 2003;54:29–52. doi:10.1146/annurev.med.54.101601.152339.

    Article  CAS  PubMed  Google Scholar 

  18. Jagasia M, Arora M, Flowers ME, Chao NJ, McCarthy PL, Cutler CS, Urbano-Ispizua A, Pavletic SZ, Haagenson MD, Zhang MJ, Antin JH, Bolwell BJ, Bredeson C, Cahn JY, Cairo M, Gale RP, Gupta V, Lee SJ, Litzow M, Weisdorf DJ, Horowitz MM, Hahn T. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood. 2012;119(1):296–307. doi:10.1182/blood-2011-06-364265.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Rowlings PA, Przepiorka D, Klein JP, Gale RP, Passweg JR, Henslee-Downey PJ, Cahn JY, Calderwood S, Gratwohl A, Socie G, Abecasis MM, Sobocinski KA, Zhang MJ, Horowitz MM. IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. Br J Haematol. 1997;97(4):855–64.

    Article  CAS  PubMed  Google Scholar 

  20. Ross WA, Ghosh S, Dekovich AA, Liu S, Ayers GD, Cleary KR, Lee JH, Couriel D. Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies. Am J Gastroenterol. 2008;103(4):982–9. doi:10.1111/j.1572-0241.2007.01639.x.

    Article  PubMed  Google Scholar 

  21. Sultan M, Ramprasad J, Jensen MK, Margolis D, Werlin S. Endoscopic diagnosis of pediatric acute gastrointestinal graft-versus-host disease. J Pediatr Gastroenterol Nutr. 2012;55(4):417–20. doi:10.1097/MPG.0b013e31825048eb.

    Article  PubMed  Google Scholar 

  22. Cornell RF, Palmer J, Komorowski R, Drobyski WR. Surgical resection as definitive treatment for refractory GVHD of the colon. Bone Marrow Transplant. 2012;47(10):1366–7. doi:10.1038/bmt.2012.15.

    Article  CAS  PubMed  Google Scholar 

  23. Gavel G, Marven S, Evans MJ, Walker J, Vora AJ. Obliterative enteritis complicating graft versus host disease. Bone Marrow Transplant. 2003;32(11):1097–8. doi:10.1038/sj.bmt.1704282.

    Article  CAS  PubMed  Google Scholar 

  24. Palaniappa NC, Doyon L, Divino CM. Colonic perforation in graft versus host disease: a case report. Int Surg. 2012;97(1):14–6. doi:10.9738/CC76.1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sarma A, Benson CB, Ho VT, Frates MC. Sonographic appearance of the gallbladder in the allogeneic hematopoietic stem cell transplant population. J Ultrasound Med. 2016. doi:10.7863/ultra.15.09005.

    PubMed  Google Scholar 

  26. Ketelsen D, Vogel W, Bethge W, Werner M, Dietz K, Claussen CD, Horger M. Enlargement of the common bile duct in patients with acute graft-versus-host disease: what does it mean? AJR Am J Roentgenol. 2009;193(3):W181–5. doi:10.2214/AJR.08.1953.

    Article  PubMed  Google Scholar 

  27. Cohen JS, Paz IB, O’Donnell MR, Ellenhorn JD. Treatment of perianal infection following bone marrow transplantation. Dis Colon Rectum. 1996;39(9):981–5.

    Article  CAS  PubMed  Google Scholar 

  28. Chen CY, Cheng A, Huang SY, Sheng WH, Liu JH, Ko BS, Yao M, Chou WC, Lin HC, Chen YC, Tsay W, Tang JL, Chang SC, Tien HF. Clinical and microbiological characteristics of perianal infections in adult patients with acute leukemia. PLoS One. 2013;8(4):e60624. doi:10.1371/journal.pone.0060624.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2011;52(4):e56–93. doi:10.1093/cid/cir073.

    Article  PubMed  Google Scholar 

  30. Perazzoli C, Feitosa MR, Figueiredo-Pontes LL, Rocha JJR, Simões BP, Féres O. Management of acute colorectal diseases in febrile neutropenic patients. J Coloproctol. 2014;34(3):189–92. http://dx.doi.org/10.1016/j.jcol.2014.06.002.

    Article  Google Scholar 

  31. Lehrnbecher T, Marshall D, Gao C, Chanock SJ. A second look at anorectal infections in cancer patients in a large cancer institute: the success of early intervention with antibiotics and surgery. Infection. 2002;30(5):272–6. doi:10.1007/s15010-002-2197-8.

    Article  CAS  PubMed  Google Scholar 

  32. Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM. Anorectal disease in neutropenic leukemic patients. Operative vs nonoperative management. Dis Colon Rectum. 1994;37(11):1095–9.

    Article  CAS  PubMed  Google Scholar 

  33. North Jr JH, Weber TK, Rodriguez-Bigas MA, Meropol NJ, Petrelli NJ. The management of infectious and noninfectious anorectal complications in patients with leukemia. J Am Coll Surg. 1996;183(4):322–8.

    PubMed  Google Scholar 

  34. Kumar S, DeLeve LD, Kamath PS, Tefferi A. Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) after hematopoietic stem cell transplantation. Mayo Clin Proc. 2003;78(5):589–98. doi:10.4065/78.5.589.

    Article  PubMed  Google Scholar 

  35. McDonald GB, Hinds MS, Fisher LD, Schoch HG, Wolford JL, Banaji M, Hardin BJ, Shulman HM, Clift RA. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Intern Med. 1993;118(4):255–67.

    Article  CAS  PubMed  Google Scholar 

  36. Helmy A. Review article: updates in the pathogenesis and therapy of hepatic sinusoidal obstruction syndrome. Aliment Pharmacol Ther. 2006;23(1):11–25. doi:10.1111/j.1365-2036.2006.02742.x.

    Article  CAS  PubMed  Google Scholar 

  37. Shulman HM, Fisher LB, Schoch HG, Henne KW, McDonald GB. Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms. Hepatology. 1994;19(5):1171–81.

    Article  CAS  PubMed  Google Scholar 

  38. Shulman HM, Hinterberger W. Hepatic veno-occlusive disease--liver toxicity syndrome after bone marrow transplantation. Bone Marrow Transplant. 1992;10(3):197–214.

    CAS  PubMed  Google Scholar 

  39. Dignan FL, Wynn RF, Hadzic N, Karani J, Quaglia A, Pagliuca A, Veys P, Potter MN, Haemato-oncology Task Force of British Committee for Standards in Haematology, British Society for Blood and Marrow Transplant. BCSH/BSBMT guideline: diagnosis and management of veno-occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation. Br J Haematol. 2013;163(4):444–57. doi:10.1111/bjh.12558.

    Article  CAS  PubMed  Google Scholar 

  40. McCarville MB, Hoffer FA, Howard SC, Goloubeva O, Kauffman WM. Hepatic veno-occlusive disease in children undergoing bone-marrow transplantation: usefulness of sonographic findings. Pediatr Radiol. 2001;31(2):102–5. doi:10.1007/s002470000373.

    Article  CAS  PubMed  Google Scholar 

  41. Richardson PG, Soiffer RJ, Antin JH, Uno H, Jin Z, Kurtzberg J, Martin PL, Steinbach G, Murray KF, Vogelsang GB, Chen AR, Krishnan A, Kernan NA, Avigan DE, Spitzer TR, Shulman HM, Di Salvo DN, Revta C, Warren D, Momtaz P, Bradwin G, Wei LJ, Iacobelli M, McDonald GB, Guinan EC. Defibrotide for the treatment of severe hepatic veno-occlusive disease and multiorgan failure after stem cell transplantation: a multicenter, randomized, dose-finding trial. Biol Blood Marrow Transplant. 2010;16(7):1005–17. doi:10.1016/j.bbmt.2010.02.009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kuttah L, Weber F, Creger RJ, Fox RM, Cooper BW, Jacobs G, Lazarus HM. Acute cholecystitis after autologous bone marrow transplantation for acute myeloid leukemia. Ann Oncol. 1995;6(3):302–4.

    CAS  PubMed  Google Scholar 

  43. Wiboltt KS, Jeffrey Jr RB. Acalculous cholecystitis in patients undergoing bone marrow transplantation. Eur J Surg. 1997;163(7):519–24.

    CAS  PubMed  Google Scholar 

  44. Day DL, Ramsay NK, Letourneau JG. Pneumatosis intestinalis after bone marrow transplantation. AJR Am J Roentgenol. 1988;151(1):85–7. doi:10.2214/ajr.151.1.85.

    Article  CAS  PubMed  Google Scholar 

  45. Hepgur M, Ahluwalia MS, Anne N, Thomas J, Liu H, Schiff MD, Loud PA, Hahn TE, Bullard Dunn KM, McCarthy Jr PL. Medical management of pneumatosis intestinalis in patients undergoing allogeneic blood and marrow transplantation. Bone Marrow Transplant. 2011;46(6):876–9. doi:10.1038/bmt.2010.208.

    Article  CAS  PubMed  Google Scholar 

  46. Bhamidipati PK, Ghobadi A, Bauer S, DiPersio JF, Pusic I. Conservative management of pneumatosis intestinalis after allogeneic hematopoietic SCT. Bone Marrow Transplant. 2014;49(11):1436–8. doi:10.1038/bmt.2014.148.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, FOB 2, GI, Tampa, FL, 33612, USA

    Julian A. Sanchez M.D., F.A.C.S.

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  1. Julian A. Sanchez M.D., F.A.C.S.
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Correspondence to Julian A. Sanchez M.D., F.A.C.S. .

Editor information

Editors and Affiliations

  1. Department of Surgery, City of Hope Medical Center, Duarte, California, USA

    Yuman Fong

  2. Department of Surgery, City of Hope Medical Center, Duarte, California, USA

    Rondi Marie Kauffmann

  3. Surgical Oncology Hepatobiliary Surgery, City of Hope Medical Center, Duarte, California, USA

    Emily Marcinkowski

  4. Department of Surgery, City of Hope Medical Center, Durate, California, USA

    Gagandeep Singh

  5. Department of Surgery, City of Hope Medical Center, Duarte, California, USA

    Hans F. Schoellhammer

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Sanchez, J.A. (2017). Emergencies in Patients with Bone Marrow Transplant. In: Fong, Y., Kauffmann, R., Marcinkowski, E., Singh, G., Schoellhammer, H. (eds) Surgical Emergencies in the Cancer Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-44025-5_25

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  • DOI: https://doi.org/10.1007/978-3-319-44025-5_25

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-44025-5

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