Dumronggittigule W, Kositamongkol P, Sirivatanauksorn Y, Limsrichamrern S, Mahawithitwong P, Tovikkai C, Sangserestid P, Assawasirisin C. Multivisceral transplantation as a rescue treatment for intestinal failure following pancreaticoduodenectomy: A case report. World J Transplant 2025; 15(3): 101427 [DOI: 10.5500/wjt.v15.i3.101427]
Corresponding Author of This Article
Prawat Kositamongkol, MD, Assistant Professor, Department of Surgery, Faculty of Medicine Siriraj Hospital, 12th floor Siamindra Building, Bangkoknoi, Bangkok 10700, Thailand. prawat.kos@mahidol.ac.th
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wethit Dumronggittigule, Prawat Kositamongkol, Yongyut Sirivatanauksorn, Somchai Limsrichamrern, Prawej Mahawithitwong, Chutwichai Tovikkai, Pholasith Sangserestid, Charnwit Assawasirisin, Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
Author contributions: Dumronggittigule W performed conceptualization, data collection, manuscript drafting, and critical revision; Kositamongkol P contributed to data collection, manuscript drafting, and critical revision; Sirivatanauksorn Y, Limsrichamrern S, Mahawithitwong P, Tovikkai C, Sangserestid P, and Assawasirisin C contributed to data collection and critically reviewed the manuscript for important intellectual content; all authors approved the final version of the paper prior to submission.
Informed consent statement: The patient gave her informed consent for the publication of this paper and its corresponding images.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prawat Kositamongkol, MD, Assistant Professor, Department of Surgery, Faculty of Medicine Siriraj Hospital, 12th floor Siamindra Building, Bangkoknoi, Bangkok 10700, Thailand. prawat.kos@mahidol.ac.th
Received: September 13, 2024 Revised: January 29, 2025 Accepted: March 17, 2025 Published online: September 18, 2025 Processing time: 216 Days and 15.3 Hours
Abstract
BACKGROUND
Post-pancreaticoduodenectomy (PD) intestinal failure (IF) is rare and associated with poor outcomes. To our knowledge, the role of intestinal transplantation (ITx) as a rescue treatment for this complication has never been reported.
CASE SUMMARY
A 42-year-old female with a benign neurilemmoma of the duodenum underwent PD. Her superior mesenteric vein (SMV) was injured during surgery and required reconstruction. She experienced SMV thrombosis and bowel gangrene requiring massive bowel resection. Consequently, she developed short gut syndrome and an enterocutaneous fistula, leading to prolonged hospitalization for wound care and total parenteral nutrition (TPN) support. She was referred to our hospital for ITx evaluation. Upon arrival, she had cholestasis due to IF-associated liver disease. After gastrointestinal (GI) reconstruction to restore GI continuity, she was eligible for multi-visceral transplantation (MVTx). The anticipated allograft included the stomach, small intestine, liver, pancreas, and duodenum. She found a suitable donor after two years of waiting. The MVTx procedure was straightforward with signs of immediate function. Enteral feeding was initiated on postoperative day (POD) 7. TPN weaning was achieved on POD 28, and the patient was discharged on POD 69. Two years post-MVTx, she is healthy with excellent graft function. To our knowledge, this is the first case report on MVTx as the treatment for fatal post-PD complications and also the first reported case of ITx in Southeast Asia.
CONCLUSION
Post-PD IF is rare and lethal. Intestinal and MVTx might be a rescue treatment for IF after GI surgery in eligible patients.
Core Tip: Herein, we report the case of a patient who developed intestinal failure due to short gut syndrome and complex enterocutaneous fistula after pancreaticoduodenectomy. This patient successfully underwent multi-visceral transplantation as a rescue treatment for this condition. We also described the challenges encountered in preparing the first intestinal transplant candidate in our country. To our knowledge, this is the first intestinal transplantation performed in Southeast Asia.
