Sclerosing encapsulating peritonitis after orthotopic liver transplantation.
BACKGROUND
The etiology of abdominal cocoon (a rare cause of intestinal obstruction) is unknown. It has occurred in adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients undergoing peritoneal dialysis. We report our experience with patients after orthotopic liver transplantation (OLT).


METHODS
Five patients (4 male, 1 female, aged 16 to 57 years) underwent OLT (3 whole liver, 2 right lobe grafts) and subsequently developed abdominal cocoon.


RESULTS
All developed pyrexia by 66 +/- 21 hours posttransplant. Additional symptoms (epigastric discomfort and intermittent vomiting) occurred 12 +/- 10 days later. Bacterial peritonitis was confirmed by microbiology in 2 cases and diagnosed by exclusion in the others. C-reactive protein levels were persistently elevated in all patients (35 to 82 mg/L). While abdominal CT consistently demonstrated marked ascites with the small intestine confined to a particular area of the abdomen, intestinal contrast studies and ultrasound were not diagnostic. All patients underwent surgical removal of the cocoon membrane by 58 +/- 22 days after transplant.


CONCLUSIONS
Sclerosing peritonitis may complicate liver transplantation and occurs because of low-grade intra-abdominal sepsis.
Maguire
D
D
Liver Transplant Unit, Kings College Hospital, SE5 9RS, London, England, UK.
Srinivasan
P
P
O'Grady
J
J
Rela
M
M
Heaton
N D
ND
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000473:pathology; D010538:Peritonitis / Q000209:etiology* / Q000473:pathology; D012598:Sclerosis