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Abdominal cocoon syndrome is a rare clinical presentation that has been associated with abdominal tuberculosis in rural India. It is also known as sclerosing encapsulating peritonitis, where the small bowel becomes encapsulated by a fibrous membrane due to unclear causes, leading to obstipation. Common symptoms include vomiting, nausea, and constipation. Due to these general clinical symptoms, it can be mistaken for other gastrointestinal disorders, resulting in delayed diagnosis, which may lead to adverse outcomes or even mortality. Surgery is often used to free the entrapped bowel and remove the fibrous tissue, while supportive care and problem management are crucial. The present case involves a 55-year-old male who presented with a distended abdomen and obstipation, leading to intestinal perforation and sclerosing encapsulating peritonitis, which was managed through resection and anastomosis of the small intestine. The patient was followed-up after three months with no new complaints. The present case helps in understanding the sequelae of acute intestinal perforation that can result in abdominal cocoon syndrome. [ABSTRACT FROM AUTHOR]

To report first deceased donor isolated small intestine transplant (DDIT) from western India and discuss feasibility, procedure and outcome of this complex surgery. A 27-year-old male required massive small bowel resection for gangrene following small bowel volvulus. Patient developed ultrashort bowel syndrome with high output stoma. He was started on total parenteral nutrition. Inability to maintain nutrition along with deranged liver functions necessitated early listing for deceased donor small intestinal transplant. DDIT was performed using small intestine from size matched for a 42-year-old female. Inflow was taken from the infrarenal abdominal aorta. The superior mesenteric vein of the graft was drained into the inferior vena cava. Standard immunosuppression and antibiotic prophylaxis were followed. The graft functioned well, and patient was completely weaned off parenteral nutrition and discharged on day 14. However, he had sudden deterioration of health at home 1 month later and succumbed to death before reaching the hospital. Small intestine transplant is a viable option in patients with intestinal failure with complications of parenteral nutrition. Post-operative care and management remains a bigger challenge. There is a need to increase the awareness and develop expertise in successful execution of this complex procedure. [ABSTRACT FROM AUTHOR]

Small bowel transplants are performed all over the world with acceptable success rates. Although there are isolated reports of small bowel transplants from India, a robust intestinal transplant programme similar to western countries is lacking. Our aim is to share our experience to build up on the evolving field of small bowel transplants in India. Deceased donor small bowel transplant was performed for three patients with intestinal failure, two for short gut syndrome following surgery and one for visceral myopathy. All were on preoperative total parenteral nutrition for varying periods of time (6 to 13 months). There were multiple episodes of line sepsis in all patients. Post-transplant, all received induction immunosuppression with anti-thymocyte globulin (first two patients) or alemtuzumab (3rd patient). All had systemic venous drainage and stoma. Protocol weekly intestinal biopsies were done in all patients. All died in hospital at 24, 12 and 28 days following surgery. Biopsy-proven rejection was observed in only patient who had received ABO-compatible non-identical graft (O to A). This patient subsequently developed vascular thrombosis necessitating explant of the graft. Sepsis due to multidrug resistant bacteria was the reason for mortality in the remaining two patients. Despite the absence of technical complications, successful small bowel transplant seems to be an elusive entity for the Indian transplant community. [ABSTRACT FROM AUTHOR]