Pune: Surgeons at the PCMC-run Yashwantrao Chavan Memorial (YCM) Hospital have successfully operated on a 20-year-old woman suffering from a rare autoimmune condition that caused her spleen to swell to five times its normal size. The complex seven-hour surgery not only saved her from potential liver failure but also eliminated the need for a future liver transplant.The patient was battling a “triple threat” health crisis—a rare combination of conditions seen in fewer than 5% of similar cases worldwide. Her immune system was attacking both her liver and its blood vessels, leading to non-cirrhotic portal fibrosis (NCPF). This caused her spleen to grow to 700 grams (normal weight is approximately 150 grams), which in turn trapped and destroyed her red blood cells, white blood cells, and platelets. As a result, she suffered from chronic anaemia and constant exhaustion.On Feb 11 this year, a team of experts led by Dr Santosh Thorat, head of the department of surgery, YCM, and a hepato-pancreato-biliary surgeon, performed a proximal splenorenal shunt (PSRS).“This was a high-stakes operation where we used micro-vascular techniques to divert blood flow from high-pressure veins to lower-pressure veins,” said Dr Thorat. “Essentially, our surgeons created a new ‘highway’ for blood flow. We also removed the enlarged spleen, allowing her body to finally retain its own blood cells. While the spleen helps the immune system, it’s not absolutely needed for survival. Now, its functions will be managed by the liver and other lymphatic tissues.“Dr Thorat likened the medical crisis to a city facing a disaster: “It was like a city facing a riot (internal tissue attack) and a major water main burst (vascular attack) simultaneously. By diverting the blood flow, we reduced the stress on her liver, preserving its function and avoiding a future transplant.” He added, “Statistically, the presence of positive IgG, ANA, and ASMA markers within the clinical framework of NCPF makes this case statistically rare. Such a convergence of autoimmune indicators and portal fibrosis is estimated to occur in fewer than 5% of cases worldwide, highlighting the diagnostic complexity of the condition.”The surgery was a complete success. Within three days, the patient’s blood counts stabilised naturally for the first time in years. She has since resumed a normal diet and no longer requires the expensive, frequent blood transfusions and endoscopic examinations that were previously keeping her alive.The woman was discharged on Feb 26 and is now preparing to return to college. She will remain on blood-thinning medication (anticoagulants) and undergo annual surveillance to monitor her liver function. Doctors noted that her kidneys remain healthy and unaffected by the condition.Before arriving at the govt-run YCM Hospital, the patient’s family had visited several private hospitals where the surgery was estimated to cost between Rs5 lakh and Rs10 lakh. At YCM, the entire procedure was performed free of charge under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) scheme.Along with Dr Thorat, the successful surgery was performed by a multidisciplinary team comprising Dr Rahul Nikam (plastic and vascular surgeon), Dr Anand Zingade (professor of surgery), Dr Mayur Bawiskar (associate professor of surgery), Dr Dattatray Toradmal, Dr Aniket Kuldipak, and Dr Aniket Narnavare.
