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Chapter 13 - Right Upper Quadrant Abdominal Pain

Published online by Cambridge University Press:  24 April 2026

By
Danna Michelle Markides
Edited by
Angela Bray Lindsay and
Monica Kathleen Wattana
Angela Bray Lindsay
Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana
Affiliation:
University of Texas, MD Anderson Cancer Center
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Summary

1. Sinusoidal obstructive syndrome (SOS)/Veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic stem cell transplant (HSCT) and chemotherapy treatment that can cause multi-organ failure, including pulmonary and renal dysfunction.

2. Suspect SOS/VOD in patients with recent stem cell transplant or chemotherapy presenting with hepatomegaly, ascites, and weight gain.

3. SOS/VOD diagnostic criteria is separated into classic and late onset SOS/VOD, which involves the presence of hyperbilirubinemia plus two or more findings of ascites, weight gain, and right upper quadrant abdominal pain.

4. Management of fluid status is critical and should be started before diagnosis is confirmed

5. Defibrotide is potentially lifesaving. Unless SOS/VOD is mild, begin this mediation when more than two diagnostic criteria are present.

Keywords

Sinusoidal obstructive syndromeveno-occlusive diseasedefibrotidehepatic complication of chemotherapyhepatic complication of antibody drug conjugateshepatic complication of hematopoietic stem cell transplantascitesjaundicehepatomegalydiagnostic criteriaemergency treatmentleukemia

Information

Type
Chapter
Information
Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
 , pp. 60 - 64
Publisher: Cambridge University Press
Print publication year: 2026

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References

Further Reading

Corbacioglu, S, Carreras, E, Ansari, M, Balduzzi, A, Cesaro, S, Dalle, JH, et al. Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients: a new classification from the European society for blood and marrow transplantation. Bone Marrow Transplant. 2018;53(2):138–145.CrossRefGoogle ScholarPubMed
Mohty, M, Malard, F, Abecassis, M, Aerts, E, Alaskar, AS, Aljurf, M, et al. Revised diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a new classification from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2016;51(7):906–912.CrossRefGoogle ScholarPubMed
Mohty, M, Malard, F, Abecassis, M, Aerts, E, Alaskar, AS, Aljurf, M, et al. Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives-a position statement from the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2015;50(6):781–789.CrossRefGoogle ScholarPubMed
Valla, DC, Cazals-Hatem, D. Sinusoidal obstruction syndrome. Clin Res Hepatol Gastroenterol. 2016;40(4):378–385.CrossRefGoogle ScholarPubMed

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