title: Diaphragmatic hernia resulting in enterothorax following pediatric liver transplantation: a rare complication.
abstract: Diaphragmatic hernia is a rare complication following solid organ transplantation. We here report three pediatric patients suffering from posttransplant enterothorax. One patient with biliary atresia presented with clinical signs of peritonitis without showing pulmonary symptoms four weeks following liver transplantation. The second patient was admitted with suspected pneumonia, whereas the third patient presented with recurrent abdominal pain over weeks and physical examination revealed the unexpected diagnosis of enterothorax. All patients received split liver transplants. Unspecific clinical signs mislead to suspected infectious complication under immunosuppression. No apparent risk factors for diaphragmatic hernia could be identified. Diaphragmatic hernia can present with a variety of atypical clinical symptoms. Severe or prolonged abdominal complains should lead to x-ray examination. We speculate that the split liver technique used in our center could lead to this rare complication due to the different anatomic position of the liver transplant in the abdomen.
authors.affiliation: Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Germany. cenglert@uke.uni-hamburg.de
authors.forename: Cornelia
authors.initials: C
authors.lastname: Englert
authors.forename: Knut
authors.initials: K
authors.lastname: Helmke
authors.forename: Andrea
authors.initials: A
authors.lastname: Richter
authors.forename: Matthias
authors.initials: M
authors.lastname: Beckmann
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.forename: Martin
authors.initials: M
authors.lastname: Burdelski
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
mesh_terms: D002675:Child, Preschool; D005260:Female; D006548:Hernia, Diaphragmatic / Q000209:etiology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*