Bowel graft versus host disease
Biopsy-proven gut graft GVHD. New moderate volume bight red fresh PR bleeding and worsening abdominal pain. Source of bleeding?
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There is diffuse bowel wall thickening with submucosal oedema 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 oedema. 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 oedema. No lymphadenopathy. Subcutaneous oedema. Lung bases are clear. No suspicious osseous lesions.
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.