What is Small bowel transplant? When a small bowel transplant is needed?

What is Small bowel transplant? When a small bowel transplant is needed?

Small bowel is also known as small intestine, which is around 20 to 30 feet long. The one end of small bowel is connected to stomach and other is connected to the large intestine. Food is broken and gets absorbed by our body in small intestine (small bowel). Small bowel transplant is the life-saving surgery performed on patients with irreversible intestinal failure; it is a complex surgery and requires expertise to perform.

What are the signs of small bowel (Intestinal) failure?

Small intestine is the longest part of the digestive system and most of the digestion occurs in small intestine. Small bowel transplant is performed due to chronic or acute intestinal failure.

Signs and symptoms of small intestinal failure:

• Diarrhea
• Vomiting
• Fatigue
• Bloating
• Malabsorption of nutrients or signs of malnutrition
• Loss or poor appetite
• Weight loss
• Liver failure

Causes of intestinal failure:

• Short bowel syndrome
• Inflammatory bowel disease (like Crohn’s disease)
• Tumor in the small bowel
• Severe infection in gastrointestinal tract
• Congenital malformations (like small bowel atresia in children)
• Absorptive impairment (like intestinal pseudo-obstruction)

What is Small bowel transplant?

Small bowel or intestinal failure means that the bowel is unable to absorb from food, the nutrients, fluids and electrolytes that are essential to live, due to short bowel syndrome or a non-functional bowel. In such condition patient is provided nutrients by TPN (Total Parenteral Nutrition) i.e. nutrients are supplied directly into a vein (Intravenous), in the form of liquid.

In small bowel (intestinal) transplant, the diseased or shortened small bowel is replaced with a healthy donor’s bowel. A small bowel transplant surgery is performed under general anaesthesia. Patient’s diseased bowel is removed; recipient’s blood vessels and digestive tract are connected to the donor’s intestine (to establish blood supply). There are three types of transplant procedures:

• Only small bowel transplant: Patient who do not have liver failure but suffer from bowel failure only.
• Combined liver and small bowel transplant: Patient with advanced liver disease can undergo both liver and small bowel transplant.
• Multivisceral transplant: A rare transplant recommended to patients with multiple organ failure, hence involves transplant of stomach, pancreas, liver, duodenum and small bowel.

When do you require a small bowel transplant?

The purpose of small bowel transplant is to restore intestinal function. Patients who are considered for small bowel transplant suffer from bowel failure with TPN dependence and complications from TPN. However, in some cases TPN is not possible at all. In such cases small bowel transplant is the only treatment option available for the patient.

For patient suffering from short bowel syndrome, the large part of their small bowel is either surgically removed or not functioning properly due to:

• Surgical removal of diseased bowel
• Intestinal trauma
• Part of the bowel tissue dies
• Short bowel at the time of birth (congenital)

In most of the cases for patients suffering from short bowel syndrome, TPN is needed. However, long-term TPN can cause some life-threatening complications like:

• Lack of suitable veins to insert catheter
• Infection due to catheter insertion, further leading to sepsis
• Liver disease

Conclusion

Small intestine is a principal organ is the digestive system and is necessary for living, unlike esophagus and large intestine, which can be surgically removed if necessary. Small intestine transplantation continues to evolve as a surgical procedure. It gives hope for patients with complication due to chronic TPN. Hence, small bowel transplant has been successful for increasing survival and providing better quality of life.