title: Extensive loculated ascites in hepatic amyloidosis.
abstract: BACKGROUND
  Amyloidosis is a disease of extracellular deposition of misfolded proteinaceous subunits, which could be systemic or localized disease. Though hepatic amyloidosis was not uncommon in autopsy series, most cases of hepatic amyloidosis were asymptomatic. Ascites, jaundice, portal hypertension, and gastrointestinal bleeding from esophageal varices were reported in literature.
  
  
  METHODS
  A 42-year-old man with end-stage renal disease on hemodialysis and recent small bowel obstruction presented with chronic abdominal pain. Computed tomography of abdomen and pelvis showed extensive loculated ascites and multiple small bowel loops tethered to adhesions and hepatomegaly. Finally, hepatic venography and liver biopsy confirmed hepatic amyloidosis with portal hypertension. The patient was waiting for liver transplant for definite treatment.
  
  
  CONCLUSIONS
  We report a rare case of hepatic amyloidosis with prior small bowel obstruction presented with extensive loculated ascites and multiple small bowel loops tethered to adhesions.
authors: Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors: Saranya
authors: S
authors: Buppajarntham
authors: Bassett Medical Center, Columbia University, New York, USA.
authors: Pongsathorn
authors: P
authors: Kue-A-Pai
keywords: Amyloidosis; Ascites; Hepatic venous pressure gradient