Bowel transplantation is a type of surgery in which the doctor replaces a person's sick small intestine with a healthy intestine from a donor. Generally, this type of transplant is necessary when there is a serious problem in the intestine, which prevents the correct absorption of nutrients or when the intestine no longer shows any type of movement, putting the person's life at risk.
This transplant is more common in children, due to congenital malformations, but it can also be done in adults due to Crohn's disease or cancer, for example, being only contraindicated after 60 years of age, due to the high risk of surgery.
When it's necessary
Intestinal transplantation is done when there is a problem that is preventing the proper functioning of the small intestine and, therefore, nutrients are not being well absorbed.
Generally, in these cases, it is possible for the person to be fed through parenteral nutrition, which consists of providing the necessary nutrients for life through the vein. However, this may not be a solution for everyone, as complications such as:
- Liver failure caused by parenteral nutrition; Recurrent infections of the catheter used for parenteral nutrition; Injuries to the veins used to insert the catheter.
In these cases, the only way to maintain adequate nutrition is to have a healthy small intestine transplant, so that it can replace the function of the one who was sick.
How is done
Intestinal transplantation is a very complex surgery that can take between 8 to 10 hours and needs to be done in a hospital with general anesthesia. During surgery, the doctor removes the affected intestine and then places the healthy intestine in place.
Finally, the blood vessels are connected to the new intestine, and then the intestine is connected to the stomach. To finish the surgery, the part of the small intestine that should be connected to the large intestine is directly connected to the skin of the belly to create an ileostomy, where the feces will go out into a bag stuck in the skin, so that it is easier for doctors assess the progress of the transplant, looking at the characteristics of the stool.
How is the recovery of the transplant
Recovery after intestinal transplantation is usually initiated in the ICU, to allow a constant assessment of how the new intestine is healing and whether there is a risk of rejection. During this period, it is common for the medical team to carry out various tests, such as blood tests and endoscopies, to ensure that healing is taking place properly.
If there is rejection of the new organ, the doctor may prescribe a higher dose of immunosuppressants, which are drugs that decrease the activity of the immune system to prevent the organ from being destroyed. However, if you are healing normally, the doctor will request a transfer to a normal ward, where painkillers and immunosuppressive drugs will continue to be administered into the vein until healing is almost complete.
Usually, after about 6 weeks after the surgery, it is possible to return home, but for a few weeks it is necessary to go to the hospital frequently for tests and continue to evaluate the functioning of the new intestine. At home, it will be necessary to always keep taking immunosuppressive drugs for the rest of your life.
Possible causes
Some causes that can cause intestinal malfunction and, consequently, the performance of an intestinal transplant include:
- Short bowel syndrome; Bowel cancer; Crohn's disease; Gardner's syndrome; Severe congenital malformations; Bowel ischemia.
However, not all people with these causes can have surgery and, therefore, it is necessary to make an assessment before surgery in which the doctor orders several tests such as X-rays, CT scans or blood tests. Some of the contraindications include cancer that has spread to other parts of the body, other serious health illnesses, and age over 60, for example.
