Covid positive boy undergoes rare paediatric living donor small intestinal transplantUpdated: Nov 22, 2020, 00:39 IST
PUNE A private hospital in the city successfully operated one of the state’s first paediatric intestinal gangrene case caused due to Covid-19. The surgery was carried out on a nine-year-old boy from Maharashtra.
According to doctors, the transplant, with the patient’s father being the donor, also highlighted the impact of the coronavirus on intestine which is a rare case.
Doctors at Jupiter hospital carried the challenging surgery on the boy who had complained of severe abdominal pain in August 2020. After diagnosis, it was found that due to thrombosis and massive gangrene in his small intestine, a condition in which the blood supply to the intestine is lost, the intestine is dead. Immediate surgery was conducted to remove his intestines to avoid further spread.
Post removal of the intestine, an antibodies test and bowel RT-PCR showed Covid-19 infection in the removed organ. Later, the family informed the hospital that the boy and his father had tested positive for Covid-19 with mild symptoms a month ago.
Dr Gaurav Chaubal, chief multi-organ transplant surgeon, said, “The child was listed for a cadaveric small intestinal transplant and was on the waiting list for three months. During this time, the child was longing to eat and also started developing complications related to parental nutrition.”
With no cadaveric organ offer insight, the prospects of a living donor small intestinal transplant were discussed with the family.
On November 5, a team of surgeons performed the surgery, wherein 200 cm of intestine was carefully harvested and transplanted from the father to the child. The surgery lasted for eight hours.
The donor has recovered completely. The child is recovering well and has started oral intake from day eight of the surgery.
Dr Rajiv Soman, infectious disease specialist from the hospital, said, “Thrombosis and bowel perforation is well known in severe Covid-19. However, massive bowel gangrene is rare. Only one 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.”
On losing his entire small bowel, before the transplant, the child was unable to eat and was put on artificial nutrition, also called parenteral nutrition. His condition was labile as there were high fluid losses and electrolyte disturbances.
Aarti Gokhale, transplant coordinator of the Zonal Transplant Coordination Committee (ZTCC), said, “This is surely the first such surgery wherein a paediatric donor has received a small bowel transplant. Earlier, Pune had performed the small bowel transplant in adults but this is the first in the state in kids.”