A nine-year-old boy from Maharashtra who suffered from severe abdominal pain post-COVID-19 was diagnosed with thrombosis and massive gangrene in his small intestine, which was recently successfully transplanted at the Jupiter Hospital, Thane.
The rare condition blocked the blood supply to the intestine causing the death of the organ and the child had to undergo immediate surgery to remove his small intestine to avoid further spread. The boy was referred to Jupiter Hospital after removal of the intestine, at a local hospital, for further management. An antibody test and bowel RT-PCR showed COVID-19 infection in the removed organ. This actually brought to light the fact that the boy and his father had tested positive for COVID-19 with mild symptoms a month ago.
“Thrombosis and bowel perforation is well known in severe COVID-19, however, massive bowel gangrene is very rare,” explains Infectious Disease Specialist Dr Rajiv Soman from Jupiter Hospital, Pune. “Only 1 such case has been reported in Italy so far, with fatal outcome. In this case, apart from intestinal gangrene, there were many secondary infections in the abdominal area – making it a complicated one.”
After removal of the small intestine, the child was put on artificial nutrition (parenteral nutrition). His condition was labile as there were high fluid losses and electrolyte disturbances.
The child was listed for a cadaveric small intestinal transplant and was on the waiting list for 3 months when he started developing complications related to parenteral nutrition. With no cadaveric organ offer in sight, the prospects of a living donor small intestinal transplant were discussed with the family.
Living donors can safely donate 40% of their intestine as the remnant intestine has a tendency to undergo adaptation and fulfil normal digestive and absorptive functions. The child’s father volunteered to donate a part of his intestine and underwent assessment.
On 5th November, a team of surgeons led by chief multi-organ transplant surgeon, Dr Gaurav Chaubal performed the surgery, wherein 200 cm of intestine was carefully harvested and transplanted from the father to the child. The surgery lasted for 8 hours with anaesthesia.
The donor has recovered completely and the child is recovering well and has started oral intake from day 8 of the surgery, said the physicians. The postoperative intensive care is being provided by paediatric intensivist Dr Shrinivas Tambe and paediatric gastroenterologist Dr Vishnu Biradar in Jupiter Hospital, Pune.
So far, Jupiter Hospital has performed three small intestinal transplants, the first one being done in March 2020. It is the only centre in Western India performing small intestinal transplants and the first centre in India to perform living donor small intestinal transplants.