Acute graft-versus-host disease of the intestine. A surgical perspective.

The general surgeon may be involved in assessment and treatment of intestinal complications in patients who have undergone bone marrow transplantation. It is important to recognize the major causes of intestinal morbidity in these patients and to be aware of the cause and natural progression of the entity of acute graft-versus-host disease. Of 89 patients who underwent allogeneic bone marrow transplantation over a 6 year period, acute intestinal graft versus host disease developed in 29 (33 percent). Although surgical consultation for abdominal pain and peritonism was requested for 15 of these patients, intestinal perforation did not occur, and only two patients underwent laparotomy, both for obstruction (and hemorrhage in one case). Patients who require operation tend to be in the end stages of the disease, and the chance for salvage appears to be remote.