Pancreas–Intestine Composite Transplantation for Simultaneous Loss of Pancreatic and Intestinal Function (With Video)

Pancreas-intestine composite transplantation (PITx) is a therapeutic option for patients with irreversible loss of both pancreatic and intestinal function. We report a case of PITx in a 16-year-old male who developed fulminant Type 1 diabetes mellitus complicated by non-occlusive mesenteric ischemia, resulting in extensive intestinal necrosis. Despite intensive surgical and critical care management, the patient ultimately required total small intestinal resection and total pancreatectomy. After recovery from sepsis and multiorgan dysfunction, the patient's general condition stabilized, and PITx was considered an appropriate therapeutic option. The composite graft consisted of the pancreas, duodenum, small intestine, and right colon. Arterial inflow was reconstructed using a single Carrel patch incorporating the celiac axis and superior mesenteric artery, and venous outflow was established by portal vein anastomosis. Postoperatively, pancreatic endocrine function was restored, allowing stable glycemic control without exogenous insulin, and intestinal graft function enabled the gradual advancement of enteral and oral nutrition. This report highlights the key technical considerations and anatomical principles of PITx and demonstrates that tailored composite graft transplantation can restore both pancreatic and intestinal function while preserving unaffected abdominal organs in highly selected patients with combined pancreatic and intestinal failure.