ABDOMINAL COMPLICATIONS IN PEDIATRIC BONE-MARROW TRANSPLANT RECIPIENTS

Abdominal problems and catastrophes often complicate the clinical cour se after bone marrow transplantation (BMT) in children. These complica tions can be grouped into categories of infection, chemotherapy and ra diation toxicity, graft-versus-host disease (GVHD), recurrent or de no vo malignancy, and miscellaneous complications and can involve the hep atobiliary system, pancreas, spleen, gastrointestinal tract, and urina ry tract. Infection is common after BMT; the causative organism depend s on the changing immunologic state of the recipient and even on envir onmental factors such as recent construction, humidity, and antibiotic use. Chemotherapy and radiation therapy can cause hepatic veno-occlus ive disease, pancreatitis, nephritis, and hemorrhagic cystitis. GVHD i s a process in which donor lymphoid cells produce damage to recipient target organs, especially skin, liver, and intestinal mucosa. Recurren t or de novo disease or malignancies, particularly B-cell lymphomas, m ay develop in chronically immunocompromised children. Other problems i nclude stone disease, splenic and renal infarction, and complications of hyperalimentation therapy. Abdominal imaging, including plain radio graphy, contrast material-enhanced studies of the bowel, real-time and duplex sonography, and computed tomography, is essential in diagnosin g these problems and evaluating response to therapy.