Vascular anastomosis and two-stage reconstruction of the gut in a living-related small bowel transplant recipient: a case report.
OBJECTIVE
We sought to discuss vascular anastomosis and gut reconstruction in a living-related small bowel transplantation recipient.


METHODS
Living-related small bowel transplantation was performed successfully on a boy with short gut syndrome in two stages. In the first stage, 120 cm, of his mother's ileum was implanted into the recipient with the artery and vein anastomosed to the recipient's sigmoid artery and inferior mesenteric vein, respectively. The two ends of the implanted intestine were constructed as stomas. In the second stage, reconstruction of the continuity of the digestive tract was performed at 188 days after the initial transplantation. The residual small bowel was transected and both ends were anastomosed to the proximal and distal end of the graft in end-to-side fashion. The stomas were closed 30 and 43 days later.


RESULTS
Both procedures were successful. Postoperative cytomegalovirus infection and acute rejection occurred successively and were controlled. No leakage of the reconstructed gut or other complications developed after the second procedure. The recipient is alive at 15 months with 8 kg an increase in weight. He is caring for himself independently and has a half-liquid diet, sometimes supplied with auxiliary enteral nutrition. A d-xylose test increased from 4.25% to 25% after the small bowel transplantation.


CONCLUSIONS
Vascular anastomoses should be performed according to the state of graft and the recipient. The portal route is the first choice when possible. A two-stage gut reconstruction could decrease the incidence of complications, and offer a useful method in living-related small bowel transplantation.
Qian
S K
SK
Second Affiliated Hospital of GuangZhou Medical College, Guangzhou, China. qiansk@126.com
Gao
L-H
LH
He
H-S
HS
Zhu
X F
XF
D000293:Adolescent; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009679:Nuclear Family; D012778:Short Bowel Syndrome / Q000601:surgery*; D020858:Tissue and Organ Harvesting