Helping a 30-year-old patient eat again, doctors at Medanta – The Medcity here have successfully conducted their first intestinal transplant at the hospital.
Announcing this on Friday, Dr. A. S. Soin, the hospital’s transplant surgeon who also led a team of 30 doctors involved in the procedure, said: “The patient, Himanshu, has undergone a successful intestinal transplant and is now getting ready to be discharged in about six weeks after the 10-hour operation on November 24 last.”
Hospital managing director Dr. Naresh Trehan said: “The teamwork required to keep the patient alive on artificial nutrition and then take him through the transplant has been phenomenal.”
The patient had suffered short bowel syndrome that results from extensive bowel removal due to blood clots in the major veins or arteries of the intestine, major abdominal trauma or inflammatory bowel diseases like Crohn’s disease.
Dr. Soin explained that intestinal failure is defined as the inability to maintain sufficient electrolyte, nutrient, and fluid balance for more than a month without intravenous (parenteral) nutrition and the most common causes of intestinal failure in adults are short bowel syndrome.
In Himashu’s case his ill-health started sometime in December 2009 when he was suddenly seized by severe abdominal pain.
Following this he underwent an emergency laparotomy at a city hospital in which the surgeons found thrombosis (blockage) of the main vein of his intestine (superior mesenteric vein) resulting in loss of blood supply to most of his intestine. Consequently, 95 per cent of his small intestine (normally 6 metres) had to be removed and only 28 cm was left. While this saved his life, he became an intestinal cripple. He could not digest anything normally ever again.
Long time coming
Senior transplant surgeon Dr. Ravi Mohanka said: “He waited for two years before a matched organ was found. During the time after his intestinal failure, he suffered several episodes of life-threatening infections and was hospitalised eleven times and underwent six minor surgeries to place or change feeding tubes into his veins.”
During surgery doctors removed most of Himanshu’s remaining small intestine and a part of the large intestine to make space for the new intestine. This was necessary as his abdominal cavity had shrunk due to the missing bowel over the past three years. The new small intestine was then transplanted, joining the blood vessels to the recipient’s and the ends of the new intestine to the existing proximal and distal bowel.
After the operation, the next big challenge was the post-operative management since intestinal transplants reject easily, much more so than any other organ.
Hospital’s Digestive Diseases Institute chairman Dr. Randhir Sud said: “While the risk of rejection is lower now than in the first six weeks, it can develop later too. This means that this monitoring must continue for at least six months.” Speaking about his surgery, Himanshu said: “I had to re-learn how to eat normally and understand the signals of satiety. Even the ‘khichdi’ given to me tasted divine.”