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Intestinal Transplant

Intestinal Transplant

 Intestinal transplant is a complex procedure, which requires a highly skilled team specialized in diverse medical disciplines. The two major types of intestinal transplantation are isolated transplant surgery, a procedure which takes three to four hours, and multi-visceral or multi-organ transplantation, which may take up to twelve hours.

Intestinal transplantation is recommended only after all other treatments for intestinal diseases have been attempted and have failed to bring results. This last-resort option offers a solution for patients with intestinal failure who have developed life-threatening complications.

Intestinal Failure and Total Parenteral Nutrition (TPN)

In some cases intestinal failure stems from a congenital disorder. It occurs when the intestines cannot digest food or absorb fluids, essential nutrients or electrolytes. In these cases, total parenteral nutrition is required. TPN provides liquid nutrition through a needle or catheter inserted into the veins, through which children receive the necessary nutrients and calories.

However, after some years, TPN can result in severe complications such as:

  • Bone disorders
  • Catheter-related infectionsIntestinal-Transplant_Smaal
  • Liver failure
  • Veins damage

When complications become life-threatening, intestinal transplant is the only viable solution for children and their family.

Further Causes of Intestinal Failure

Short bowel syndrome is the most common cause of intestinal failure, in which half or more of the small intestine has been removed, as a treatment for conditions such as necrotizing enterocolitis or trauma. Other conditions that typically may lead to intestinal failure are Crohn’s disease (a digestive disorder) and chronic idiopathic intestinal pseudo-obstruction syndrome.

Further conditions which may cause intestinal failure and necessitates intestinal transplant include:

  • Congenital malformations – bowel atresia, gastroschisis, aganglionosis
  • Gastrointestinal tract infection – necrotizing enterocolitis
  • Short bowel syndrome – mesenteric ischemia, thrombosis, embolism, volvulus, trauma
  • Absorptive impairment – microvillus inclusion disease, intestinal pseudo-obstruction
  • Inflammatory bowel disease
  • Small bowel tumors
  • Desmoid tumor

Types of Intestinal Transplants

 The most commonly conducted intestinal transplantations are:

  • Isolated intestinal transplantation (for small bowel) – where the diseased portion of the small intestine is removed and replaced with a donor’s healthy small intestine.
  • Combined liver and intestinal transplantation – whose main triggering factors are complications of TPN.
  • Multivisceral transplant – is performed when several intra-abdominal organs are failing, including stomach, pancreas, liver, duodenum and intestine.

Among the tests performed to evaluate and determine intestinal transplant viability, we find:

  • CT scans in the abdominal area
  • Barium enema
  • Blood tests
  • Colonoscopy
  • Echocardiogram and ECG
  • Endoscopy
  • Motility studies
  • Ultrasound
  • X-ray

During the procedure usually performed at specialized intestinal transplant centers, the diseased section of the small bowel and other failing organs are removed and replaced with a healthy organ.

Ileostomy, a surgical procedure to create an opening through which the ileum is brought up through the abdominal wall, is also performed to allow body waste to pass out of the body. Finally, a feeding tube is placed into the stomach after ileostomy, to help the patient transition to the oral diet.

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