Acute Abdomen After Allogenic Haematopoietic Stem Cell Transplantation

Crocoli, Alessandro; Pagliara, Daria; Locatelli, Franco; Inserra, Alessandro

doi:10.4081/pr.2011.e32

Cited by 1 publication

(3 citation statements)

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“…In the early post-engraftment period, the main differential diagnoses include GVHD, viral enteritis (with CMV being the leading cause), pseudomembranous colitis, and other less common causes such as pneumatosis intestinalis, and intestinal thrombotic microangiopathy. On the contrary, the incidence of ACPO after allogeneic SCT is unknown, and can only be suspected to be very rare since only a few cases have been described in the literature [10]. Moreover, unless recognized and promptly managed, ACPO could lead to a life-threatening condition.…”

Section: Discussionmentioning

confidence: 99%

“…Delay in decompression, especially in patients with old age or debilitating conditions, influences outcome, and the mortality rate is approximately 40% when ischemia or perforation occurs [2]. Options for non-surgical mechanical approaches include colonoscopic decompression with tube placement or percutaneous cecostomy performed through a combined endoscopic-radiologic approach [1, 2, 10]. According to retrospective series, overall colonoscopic success rates are estimated at approximately 70.80% with varying percentages of complications, although colonoscopy in ACPO is a technically difficult procedure [2].…”

Section: Discussionmentioning

confidence: 99%

“…According to retrospective series, overall colonoscopic success rates are estimated at approximately 70.80% with varying percentages of complications, although colonoscopy in ACPO is a technically difficult procedure [2]. Surgical interventions, because of the significant sequelae and mortality related to procedures, must only be considered for patients with signs of bowel ischemia or perforation or who fail non-surgical decompression methods [1, 2, 10]. …”

Section: Discussionmentioning

confidence: 99%

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Acute colonic pseudo-obstruction following allogeneic stem cell transplantation successfully treated by neostigmine

et al. 2013

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Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare clinical syndrome of massive large bowel dilatation without mechanical obstruction, which may cause significant morbidity and mortality. Treatment focuses on decompressing a severely dilated colon. The proposed theory that this severe ileus results from an imbalance in the autonomous regulation of colonic movement supports the rationale for using neostigmine, a reversible acetylcholinesterase inhibitor, in patients who failed conservative care. Although gastrointestinal complications are frequent following allogeneic stem cell transplantation (SCT), the incidence of ACPO in a transplant setting is unknown and, if not vigilant, this adynamic ileus can be underestimated. We describe the case of a patient with myelodysplastic syndrome undergoing non-myeloablative allogeneic SCT from a partially human leukocyte antigen-mismatched sibling donor, and whose clinical course was complicated by ACPO in the early post-engraftment period. The ileus was not associated with gut graft-versus-host disease or infectious colitis. After 3 days of conservative care, intravenous neostigmine (2 mg/day) was administered for 3 consecutive days. Symptoms and radiologic findings began to improve 72 hours after the initial injection of neostigmine, and complete response without any associated complications was achieved within a week. Thus, neostigmine can be a safe medical therapy with successful outcome for patients who develop ACPO following allogeneic SCT.

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Section: Discussionmentioning

confidence: 99%