Bowel graft versus host disease

Case contributed by Heather Pascoe
Diagnosis almost certain


Biopsy-proven gut graft GVHD. New moderate volume bight red fresh PR bleeding and worsening abdominal pain. Source of bleeding?

Patient Data

Age: 40 years
Gender: Female

There is diffuse bowel wall thickening with submucosal edema involving the entire small and large bowel as well as the stomach. No bowel dilatation. No focus of active bleeding identified. Small volume of free fluid in the pelvis. No free gas. No focal liver lesion. Mild periportal edema. Cholelithiasis and gallbladder sludge.

The spleen, kidneys, pancreas and adrenal are unremarkable. The portal and splenic veins are patent. Mild diffuse bladder wall thickening. Subcutaneous edema. No lymphadenopathy. Subcutaneous edema. Lung bases are clear. No suspicious osseous lesions. 

Case Discussion

Diffuse bowel wall thickening involving the entire small and large bowel as well as the stomach. Findings are compatible with graft versus host disease given the clinically history however superimposed infection remains a possibility. 

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