Irani and colleagues address a difficult problem: how to surgically treat a patient who has had a stem cell transplant and is suspected of having GI manifestations of GVHD. This complication poses a serious risk to the patient's life, as most patients will ultimately die, although not of surgically correctable reasons. Most commonly, surgeons are asked to see patients with GI GVHD because of abdominal pain, distention, and bleeding. These are challenging patients, as they are immunosuppressed, thus the signs of peritonitis may potentially be masked.