Abdominal Complications Following Hematopoietic Stem Cell Transplantation

Abstract

Abdominal complications affect more than 80% of patients who undergo hematopoietic stem cell transplantation (HSCT) for treatment of benign or malignant hematologic disease and some solid tumors. HSCT can be performed using cells from bone marrow, peripheral blood, or umbilical cord blood. These stem cells may be from the patient him- or herself (autologous transplant), from relatives or nonrelatives with very similar human leukocyte antigen (allogeneic transplant), or from an identical twin (syngeneic transplant). Posttransplantation complications are classified according to the amount of time elapsed between transplantation and onset. Complications that occur during the first 100 days are divided into preengraftment phase complications (≤30 days after transplantation) and early posttransplantation phase complications (31-100 days after transplantation) and include infectious and noninfectious conditions such as hepatic veno-occlusive disease (VOD), hemorrhagic cystitis, neutropenic colitis, benign pneumatosis, and acute graft-versus-host disease (GVHD). Hepatic VOD, neutropenic colitis, and acute hemorrhagic cystitis are associated with the pretransplantation conditioning regimen. After the first 100 days, chronic GVHD and lymphoproliferative disease are the main complications. Computed tomography and ultrasonography are the primary imaging techniques used in HSCT patients and can help make an early diagnosis, grade the severity of impact, and (if necessary) recommend further investigations to confirm the diagnosis.

Attenuation of graft‐versus‐host‐disease in NOD scid IL‐2Rγ−/− (NSG) mice by ex vivo modulation of human CD4+ T cells

“…GvHD is a major and often lethal complication following HSCT (2,5,6). It can be classified into an acute and a chronic form based on the time of onset and appears clinically as an inflammation mainly of the skin, the gut, and the liver (2,(6)(7)(8).…”

Unintended Consequences of Systemic and Ablative Oncologic Therapy in the Abdomen and Pelvis

“…Imaging findings of SOS include those commonly seen as sequelae of portal hypertension, including decreased or reversed (hepatofugal) portal venous flow, splenomegaly ( Fig 5), periportal edema, gallbladder wall thickening, ascites, paraumbilical vein patency, and increased hepatic artery resistive index (>0.8). The presence of narrowed hepatic veins (right hepatic vein diameter ≤0.45 mm) with monophasic flow at ultrasonography (US) has also been described (42,43,45). Magnetic resonance (MR) imaging may show signs of hepatic congestion including heterogeneous predominantly low signal intensity on T1weighted images and predominantly high signal intensity on T2-weighted images with diffuse heterogeneous enhancement and intrahepatic venous collaterals, but no venous thrombosis (46).…”

“…Agents such as cyclophosphamide and busulfan are used in myeloablative regimens. Autologous transplantation has a lower incidence of treatment-related complications; however, the risk of tumor recurrence is higher (45). Patients undergo myeloablative conditioning, followed by infusion of stem cells from either bone marrow or peripheral blood to support hematopoiesis (99).…”

“…Complications related to HSCT vary on the basis of the timeline of therapy. During the pre-engraftment period (≤30 days after stem cell infusion), patients who have undergone myeloablative therapy are severely pancytopenic and thus at risk for serious bacterial and fungal infections (45). These infections may manifest as microabscesses in the liver, spleen, or kidneys.…”

Benign Diseases of the Colon and Rectum (incl. CT colonography)

“…Engorged mesenteric vascularization, fat stranding, and ascites may be present. In chronic stages, submucosal edema is replaced by fat tissue [35]. Clinical history leads to the specific diagnosis.…”