Korean J Radiol.  2008 Oct;9(5):449-457. 10.3348/kjr.2008.9.5.449.

Gastrointestinal Complications Following Hematopoietic Stem Cell Transplantation in Children

• Lee JH
• Lim GY
• Im SA
• Chung NG
• Hahn ST

• KMID: 1385404
• DOI: http://doi.org/10.3348/kjr.2008.9.5.449

Abstract

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. We present here a pictorial review of the imaging features and other factors involved in the diagnosis of these gastrointestinal complications in pediatric HSCT recipients.

Keyword

Hematopoietic stem cell transplantation; Pediatric; Complications; Gastrointestinal tract

MeSH Terms

Child
*Diagnostic Imaging
Gastrointestinal Diseases/*diagnosis/*etiology
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans

Figure

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  Fig. 1 Neutropenic colitis in 10-year-old boy, and this developed on 23rd day after bench mark test for treating his leukemia. A, B. US of right lower guadrant abdomen shows marked asymmetric echogenic wall thickening and abundant vascular flow of cecum (A) and terminal ileum (B). C. CT scan shows thickening of cecal wall with associated luminal narrowing and stranding in pericecal fat (arrow).

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  Fig. 2 Pseudomembranous colitis in 9-year-old boy, and this developed on 23rd day after bench mark test for treating his leukemia. A. Longitudinal US of ascending colon shows rather striking diffuse thickening of colonic wall (arrows). Exaggerated haustral markings and inhomogenously thickened submucosa with apposition of muscosal surfaces of thickened wall are noted. B, C. Axial contrast enhanced CT shows pancolitis involving ascending, transverse, descending (B) and rectosigmoid colon (C). Note the hyperemic enhancing mucosa surrounded by thickened hypodense submucosa edema, which forms accordion pattern (arrows).

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  Fig. 3 Cytomegalovirus enteritis in 15-year-old boy, and this developed during second month after bench mark test for treating his aplastic anemia. A, B. US of abdomen shows multiple sites of segmental hypoechoic bowel wall thickening that involves terminal ileum (A), and there are abundant Doppler signals with ascites (B).

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  Fig. 4 Acute graft-versus-host disease in 12-year-old boy, and this developed on 32nd day after bench mark test for treating his leukemia. A, B. US of abdomen shows slightly thickened echogenic wall (arrows) (A) and fluid (*) distended small bowel loops with ascites (B).

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  Fig. 5 Acute graft-versus-host disease in 11-year-old-boy, and this developed on 40th day after bench mark test for treating his leukemia. A, B. Axial contrast-enhanced CT scans show ascites and diffuse wall thickening with mucosal enhancement involving small bowel (long arrows) and large bowel (short arrows). C. Coronal MPR contrast-enhanced CT demonstrates more pronounced engorgement of vasa recta (arrow) adjacent to thickened bowel wall segment, as well as multiple, fluid-filled, dilated loops of colon without wall thickening in sigmoid colon (*). Abnormal enhancement of gall bladder and urinary bladder is also present, and this is similar to that seen within bowel wall.

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  Fig. 6 Benign pneumatosis intestinalis in 15-year-old asymptomatic boy, and this developed on 75th day after BMT for treating his leukemia. A. Plain film of abdomen shows diffuse linear and bubbly intramural air along entire colon, as well as presence of subhepatic gas. B. CT scan shows diffuse intramural air densities in entire colon with involvement of retroperitoneal (arrows) and intraperitoneal cavities.

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  Fig. 7 Intestinal thrombotic microangiopathy followed by graft-versus-host disease in 13-year-old girl, and this developed on 28th day after peripheral blood stem cell transplantation for treating her leukemia. A, B. US shows multiple distended small bowel loops with wall thickening. Medium echogenic debris with floating echogenicities that fill distended lumen are noted in some of these loops (*). C. Unenhanced coronal multiplanar reconstruction CT image shows increased intraluminal attenuation, which is consistent with intraluminal bleeding (*), and submucosal zone of decreased attenuation parallel to lumen (arrowhead). Ascites and mesenteric thickening are also noted.

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  Fig. 8 Megacolon in 14-year-old boy with neutropenic colitis, and this developed on 39th day after peripheral blood stem cell transplantation for treating his leukemia. A. Initial CT shows diffuse concentric thickening with increased vascularity involving cecum and ascending colon (arrows). Lumen is distended and partially fluid-filled. B. Follow-up CT one month later shows resolution of previous wall thickening, but there is also marked fluid/gas-distended right side of colon, which appears as megacolon (arrows).

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  Fig. 9 Post-transplantation lymphoproliferative disease involving small bowel in five-year-old boy, and this developed during third year following bench mark test for treating his leukemia. A. Longitudinal US of left mild abdomen shows short area of segmental severe concentric hypoechoic mural thickening (*), and this causes luminal narrowing in jejunum. B. CT scan shows short area of segmental concentric wall thickening with homogenous enhancement of small bowel loop in left side of abdomen (arrow).

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