SMALL BOWEL TRANSPLANTATION: THE FIRST

Abstract

Fifty-three-year old white male patient had undergone an emergency surgical intervention due to acute mesenteric vascular disease. In the exploration, the entire small bowel and right colon seemed necrotized. The small bowel, from 10 cm distal to Trietz ligament up to the transverse colon, was resected and duodeno-colic anastomosis was performed. Small bowel transplantation was thought to be indicated. Cadaveric small bowel transplantation was performed to this patient for the first time in Turkey. The cold ischemia time was 4 hours. The proximal end of the graft was anastomozed to duodenum by a stapler. The distal end was brought as an ileostomy. The patient received a triple immunosuppressive protocol consisting prednisolone, tacrolimus and micophenolate mofetil. The patient was fed by jejunostomy on the first day and orally on the eight day. He experienced an acute rejection episode on the 17th day. In the last ten years; the increase in clinical experience, developments in immunosuppressive therapy and new surgical techniques has brought small bowel transplantation to become a reliable alternative to the long term TPN therapy in the short bowel syndrome.