Multivisceral transplantation as a rescue treatment for intestinal failure following pancreaticoduodenectomy: A case report.

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.