After gap of three years, patient now able to eat food
Himanshu, 30, got a new lease of life when the rare intestinal transplant was carried out on him. It was after three years that he could eat food and digest it too. It took 10 hours for the operation that was conducted six weeks ago.
In December 2009, Himanshu felt acute abdominal pain. He was diagnosed with blockage in the main vein of his intestine resulting in loss of blood supply to the intestine.
Consequently, 95 per cent of his small intestine had to be removed and only 28 cm was left. The normal length of the small intestine is six metre.
Not being able to absorb the nutrients his body needed, he remained dependent on intravenous nutrition.
During the three years after his intestinal failure, he suffered many life-threatening infections and was hospitalised 11 times. He underwent six minor surgeries to place or change feeding tubes into his veins.
The family had approached Medanta Hospital where he was listed for intestinal transplant.
The blood group of a 20-year-old dead person’s matched that of Himanshu’s and the transplant was conducted on November 24, 2012.
The chairperson of the institute of transplantation and chief surgeon at the hospital, Dr A S Soin said, intestinal failure is defined as the inability to maintain sufficient electrolyte, nutrient, and fluid balance for more than one month without intravenous (parenteral) nutrition.
Patients with intestinal failure are considered candidates for transplant when total parenteral nutrition (TPN) has been tried for a while, but cannot be tolerated due to complications. And the remaining intestine cannot adapt enough to recover its function.
Short bowel syndrome
He added that the common causes of intestinal failure in adults are short bowel syndrome, major abdominal trauma or inflammatory bowel diseases like Crohn’s disease. In children it is usually due to failure of intestinal development or gastroschisis.
Many people with short bowel syndrome, like Himanshu, are dependent on TPN to supply their daily nutrition.
Dr Ravi Mohanka, transplant surgeon at the hospital said, a major problem with such patients is the difficulty of differentiating between rejection and infection since both produce the same symptoms. The differentiation is vital as the treatment of both conditions is different.
Last year, Sir Ganga Ram Hospital conducted an intestinal transplant. The recipient lived for eight weeks. It was a live donor transplant while the present case is of cadaver transplant.
In live donor transplant 200 cm of intestine is available in contrast to 600 cm in cadaver transplant.