Sclerosing encapsulating peritonitis in a liver transplant patient: a case report

Abstract

We report a patient with HBV-related hepatocellular carcinoma (HCC) and refractory ascites who had received a peritoneal-venous shunt (PVS) 1 year before liver transplantation. Urgent surgical intervention following bowel obstruction and failure of immunosuppression therapy. No intestinal obstruction was found during an initial PVS. However, intestinal obstruction developed 2 wk after liver transplantation; and a cocoon abdomen was found upon exploration. This is the first reported case of cocoon abdomen caused by PVS and exacerbated by liver transplantation.

Figure 1

Contrasted abdominal CT revealed a cluster of intestinal loops sacculated in thin, membrane-like sac (black arrow).

Figure 2

Dense thick adhesive sheaths circumferentially wrapping loops of small bowel giving the shape of cocoons in the abdomen (A); we excised these fibrous tissues easily using finger dissection (B); the serosa was intact and there was no need for bowel resection (C).