Objective To investigate the application value of modified multivisceral trans-plantation (MMT) in chronic intestinal pseudo⁃obstruction (CIPO) secondary to autoimmune enteril leiomyositis (AEL).

Methods The retrospective and descriptive study was conducted. The clinico-pathological data of a recipient who was admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University on February 2022 and underwent MTT for CIPO secondary to AEL were collected. The recipient was a male, aged 29 years old. Results of preoperative histopathological examination showed that there were muscle plexus and ganglion cells in the rectum, sigmoid colon, ascending colon, intrinsic muscle layer of ileum, and a small amount of submucosal layer. There was also a small amount of chronic inflammatory cell infiltration in the muscle, indicating a high possi-bility of diagnosis of neurogenic CIPO.

Results (1) Surgical situations. The operation time was 14 hours and 30 minutes, and the cold ischemia time was 9 hours and 30 minutes. The intra-operative blood product dosage included 14 U of red blood cells, 1 400 mL of fresh frozen plasma, and two therapeutic doses of platelets. (2) Postoperative histopathological examination. Results of postoperative histopathological examination showed chronic inflammation and local erosion of the small intestine and duodenal mucosa, with scattered disappearance of the focal mucosal muscle layer; There is a large infiltration of CD3⁺ and CD8⁺ lymphocytes in the lamina propria, especially in the muscularis propria. In severe lesions, there is infiltration of ribbon lymphocytes in the subserosal and muscular layers; Muscle fiber degeneration, reduction, and fibrosis. Deposition of pigment granules in the cytoplasm of smooth muscle cells; No abnormalities were found in the intermuscular, submu-cosal ganglia, and Cajal cells; Fibrosis of the serosal layer with local cellulose exudation; Chronic inflammation of the colonic mucosa, scattered and focal lymphocyte infiltration in the local muscle layer, and myositis related changes. Pathological diagnosis was secondary CIPO induced by AEL. (3) Postoperative immune rejection, recurrence and treatment. Results of colonoscopy and histopatholo-gical examination at postoperative 8 days showed acute cellular rejection. The cell count of reci-pient′s B lymphocytes, CD3⁺ lymphocytes, CD4⁺ lymphocytes, and CD8⁺ lymphocytes were 27.00×10³, 373.00×10³, 179.00×10³ and 142.00×10³ cell/mL, respectively. Anti‑immune rejection treatment was performed using tacrolimus, rabbit anti‑human thymocyte immunoglobulin, methylprednisolone mycophenolate mofetil, and monoclonal antibodies against basil. The cell count of recipient′s B lymphocytes, CD3⁺ lymphocytes, CD4⁺ lymphocytes, and CD8⁺ lymphocytes at postoperative 57 days were 0.72×10³, 239.59×10³, 89.28×10³ and 91.53×10³ cell/mL, respectively. Results of colonoscopy and histopathological examination at postoperative 79 days showed the recurrence of AEL. The cell count of recipient′s B lymphocytes, CD3⁺ lymphocytes, CD4⁺ lymphocytes, and CD8⁺ lymphocytes were 0.32×10³, 264.92×10³, 46.95×10³ and 169.54×10³ cell/mL, respectively. The tacrolimus and methylprednisolone were used for treatment. Results of colonoscopy and histopathological examina-tion at postoperative 89 days showed AEL recurrence without remission. The cell count of recipient′s B lymphocytes, CD3⁺ lymphocytes, CD4⁺ lympho-cytes, and CD8⁺ lymphocytes were 0.28×10³, 187.00×10³, 55.52×10³ and 92.45×10³ cell/mL, respec-tively. The tacrolimus and methylprednisolone were used for treatment. Results of colonoscopy and histopathological examination at postoperative 92 days showed the intestinal mucosa had returned to a normal state. (4) Postoperative oral feeding time and time to get rid of parenteral nutrition. The recipient began oral feeding at postoperative 28 days and eliminated parenteral nutrition at postoperative 35 days. (5) Follow‑up. The recipient was discharged 114 days after surgery and as of the follow-up deadline, the graft function was good. The recipient maintained a low‑fat, high sugar, and high protein diet, completely consumed orally, with a body mass index of 22 kg/m², and has returned to normal work.

Conclusion MMT can be used for the treatment of CIPO secondary to AEL.