title: Acquired intestinal lymphangiectasia successfully treated with a low-fat and medium-chain triacylglycerol-enriched diet in a patient with liver transplantation.
abstract: Intestinal lymphangiectasia is defined as a dilatation of small bowel lymphatic capillaries and a loss of lymph into the bowel lumen. Clinically it is characterized by hypoproteinaemia and oedema. We present here a case of protein-losing enteropathy due to intestinal lymphangiectasia after liver transplantation in a 57-year-old man who was transplanted for hepatitis C virus. Four years after liver transplantation, the patient developed hypoalbuminaemia and ascites associated with recurrence of cirrhosis. The sudden fall in serum albumin led us to look for a cause of reduction other than or in addition to cirrhosis. Duodenal biopsies showed tall villi with dilated lymphatic vessels and widening of the villi caused by oedema, demonstrating intestinal lymphangiectasia. In this case a low-fat diet supplemented with medium-chain triacylglycerols achieved an early clinical improvement with increased serum albumin levels and ascites disappearance. Intestinal lymphangiectasia should be suspected in liver-transplanted patients developing hypoproteinaemia and hypoalbuminaemia after the recurrence of cirrhosis.
authors.affiliation: Semeiotica Medica, Dipartimento Medicina Interna, Cardioangiologia ed Epatologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Biselli
authors.forename: Pietro
authors.initials: P
authors.lastname: Andreone
authors.forename: Annagiulia
authors.initials: A
authors.lastname: Gramenzi
authors.forename: Carmela
authors.initials: C
authors.lastname: Cursaro
authors.forename: Stefania
authors.initials: S
authors.lastname: Lorenzini
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Bonvicini
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
mesh_terms: D018752:Diet, Fat-Restricted / Q000379:methods*; D004386:Duodenum / Q000473:pathology; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D016031:Liver Transplantation; D008201:Lymphangiectasis, Intestinal / Q000150:complications / Q000178:diet therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000178:diet therapy* / Q000473:pathology; D011504:Protein-Losing Enteropathies / Q000178:diet therapy / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome; D014280:Triglycerides / Q000008:administration & dosage*
chemical_list: D014280:Triglycerides