Irani et al listed indications for obtaining a surgical consult in a patient with severe acute gastrointestinal graft-vs-host disease (GVHD). The authors are from Dana-Farber Cancer Center, Brigham and Women's Hospital and Harvard Medical School.
GVHD of the gastrointestinal tract may affect:
(1) the stomach
(2) the small intestine
(3) the colon and rectum
Indications for requesting a surgical consultation:
(1) bowel obstruction that persists with conservative management
(2) ischemic bowel disease
(3) evidence of air or gas release (pneumoperitoneum, pneumatosis intestinalis)
(4) evidence of hemorrhage (ongoing intraperitoneal hemorrhage and/or intraluminal bleeding not controlled during endoscopy)
(5) peritonitis
(6) progressive abdominal pain and tenderness
Management is conservative if the process appears limited and if the patient is hemodynamically stable. The presence of multiple indications tends to favor surgery.
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