title: Sclerosing encapsulating peritonitis after orthotopic liver transplantation.
abstract: 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.
authors.affiliation: Liver Transplant Unit, Kings College Hospital, SE5 9RS, London, England, UK.
authors.forename: D
authors.initials: D
authors.lastname: Maguire
authors.forename: P
authors.initials: P
authors.lastname: Srinivasan
authors.forename: J
authors.initials: J
authors.lastname: O'Grady
authors.forename: M
authors.initials: M
authors.lastname: Rela
authors.forename: N D
authors.initials: ND
authors.lastname: Heaton
mesh_terms: 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