56yr old, Abdul was rushed to a private hospital in Kalyan as he started experiencing severe pain in his chest coupled with profuse sweating. Upon admission, he was diagnosed with Ischemic Heart Disease; this involves a reduced supply of blood to the heart due to blockages in the arteries. Post diagnosis, he was shifted to Fortis Hospital, Mulund, where the team of doctors performed a Coronary Bypass Grafting surgery, to improve blood supply to the patient’s heart; the operative course was uneventful.
Post-surgery, he was shifted to the ward, when he complained of pain in abdomen and started experiencing loose watery stools, with frequency of about 5-6 times a day. This was accompanied by a fever, which raised severe concerns amongst doctors at the hospital. After initial blood tests, he was put on a course of Antibiotics to control the infection and bring down his fever. However, during the treatment, it was also noted that there was a drop in his blood pressure along with reduced kidney function; and he was moved back into the ICU.
During the second round of investigations, the patient was diagnosed with a bacterial infection, named ‘Clostridium Diffcille’ which leads to a severe condition known as ‘Clostridium Difficile Colitis’. The Clostridium Difficile bacterium is a normal flora of the human colon, however as the bacteria overgrows, it turns harmful and releases toxins in the intestine. This causes swelling and irritation of the colon or the large intestine. The large intestine usually contains good bacteria, however, if antibiotics are consumed regularly for various medical reasons, there is a chance of killing the good bacteria and allowing bad bacteria to grow. A reduction in bacteria is seen due to unchecked use of Antibiotics. Clostridium Difficile Colitis is considered to be a major complication of Antibiotic Therapy.
Eventually, the patient was put on a ventilator, and started on Dialysis to improve Kidney function. Appropriate medication was administered to him; however, none seemed to be working for the inflammation and imbalance of the intestine for the Colitis to settle. Thus, Dr. Kirti Sabnis, Infectious Disease Physician, Fortis Hospital, Mulund, and her team proposed a lesser known therapy in India for Clostridium Difficile Colitis, a stool transplant known as Faecal Microbiota Transplant. The procedure involves restoration of the gut flora by introducing healthy bacterial flora from a healthy donor (preferably relative) to the recipient. This is carried out through infusion of stool, by enema, tube or by mouth in the form of slurry or capsule.
Speaking on the transplant, Dr. Kirti Sabnis, Infectious Disease Physician, Fortis Hospital, Mulund, said, “Upon weighing the pros and cons, the procedure was explained to the patient and his family, who consented to undergo the transplant. We performed the Faecal Transplant in two sessions, 3 days apart. The patient initially responded well to treatment for the first 4-5 days however, he continued to have abdominal distension. We decided to perform another procedure, which involves the removal of a particular section of the large intestine called as ‘Subtotal Colectomy’ in this procedure the severely involved part of large intestine is removed. This procedure was also high risk as he was on ventilator with supports for his Kidney, and to maintain his BP. Dr. N. Arulvanan, General & Laparoscopic Surgeon at the hospital performed the procedure. The patient tolerated the procedure well and was gradually weaned off the ventilator and dialysis support”.
Post the surgery, the patient responded well to treatment and was discharged after a hospital stay of 3 months. He recently returned for the final leg of the procedure, restoration of the large intestine. It is a concluding surgery where the tube, which was substituting for the part of the intestine, called the Colostomy Tube, will be removed and his small intestine will be stitched back to remaining large intestine. Dr Kirti Sabnis, further added, “The final surgery is slated for next week. We can proudly say that multispecialty approach enabled us to go forth with this procedure, marking 1st of Western India. The patient is being closely monitored and will be able to go about with a normal and healthy lifestyle”.
About Faecal Microbiota Transplant: This is a less recognized therapeutic option in India, for severe Clostridium Difficle Colitis as well as in Ulcerative Colitis.
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