Ann Surg Treat Res.  2017 Mar;92(3):164-167. 10.4174/astr.2017.92.3.164.

Encapsulating peritoneal sclerosis in liver transplant recipients: a report of 2 cases

• Lee KW
• Cho CW
• Lee N
• Lee S
• Kim JM
• Choi GS
• Kwon CH
• Joh JW
• Lee SK

• KMID: 2377559
• DOI: http://doi.org/10.4174/astr.2017.92.3.164

Abstract

Encapsulating peritoneal sclerosis (EPS) is a rare cause of intestinal obstruction by a thick fibrous membrane wrapping around the small intestine. It is a possible complication after liver transplantation (LT) that can be fatal. This report describes 2 cases of EPS after LT that were successfully treated with surgery, corticosteroids, tamoxifen, and mammalian target of rapamycin inhibitor. After treatment in both cases, the patients were able to start oral feeding and have been symptom free for more than 1 year. These cases suggests that for the management of EPS, surgical treatment is mandatory when the patients present with symptoms of intestinal obstruction or if there are findings suggestive of decreased mural perfusion. Surgery should be accompanied with medical treatment to prevent the relapse of EPS.

Keyword

Peritoneal fibrosis; Liver transplantation; Intestinal obstruction

MeSH Terms

Adrenal Cortex Hormones
Humans
Intestinal Obstruction
Intestine, Small
Liver Transplantation
Liver*
Membranes
Perfusion
Peritoneal Fibrosis*
Recurrence
Sirolimus
Tamoxifen
Transplant Recipients*
Adrenal Cortex Hormones
Sirolimus
Tamoxifen

Figure

• 

  Fig. 1 (A) Abdominal X-ray appearance was not like mechanical obstruction. (B) Contrast abdominal CT revealed large amount of ascites and small bowel wrapped with capsule.

• 

  Fig. 2 (A) Surgical finding showed thick fibrous membrane wrapping the small intestine and colon. (B) Careful dissection and excision of the thick membrane to release the small intestine were performed without additional injury of the intestinal serosa.

• 

  Fig. 3 (A) Upper gastrointenstinal series revealed that distended stomach and jejunum with delayed passage. (B) Abdominal CT revealed diffuse thickening of visceral peritoneum of small bowel loop with suspicious adhesion and decreased mural enhancement of terminal ileum (arrow).

• 

  Fig. 4 (A) Thick fibrous membrane wrapping the abdominal organs was shown. (B) Terminal ileum resection and anastomosis, and careful dissection and excision of the thick membrane were performed.

Reference

1. Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. Perit Dial Int. 2000; 20:Suppl 4. S43–S55.

2. Korte MR, Sampimon DE, Betjes MG, Krediet RT. Encapsulating peritoneal sclerosis: the state of affairs. Nat Rev Nephrol. 2011; 7:528–538.

3. Korte MR, Yo M, Betjes MG, Fieren MW, van Saase JC, Boer WH, et al. Increasing incidence of severe encapsulating peritoneal sclerosis after kidney transplantation. Nephrol Dial Transplant. 2007; 22:2412–2414.

4. Khanna A, Plummer M, Bromberek C, Bresnahan B, Hariharan S. Expression of TGF-beta and fibrogenic genes in transplant recipients with tacrolimus and cyclosporine nephrotoxicity. Kidney Int. 2002; 62:2257–2263.

5. Mekeel K, Moss A, Reddy KS, Douglas D, Mulligan D. Sclerosing peritonitis and mortality after liver transplantation. Liver Transpl. 2009; 15:435–439.

6. Takeichi T, Narita Y, Lee KJ, Yamamoto H, Asonuma K, Inomata Y. Sclerosing encapsulating peritonitis after living donor liver transplantation: a case successfully treated with tamoxifen: report of a case. Surg Today. 2013; 43:1326–1329.

7. Honda K, Oda H. Pathology of encapsulating peritoneal sclerosis. Perit Dial Int. 2005; 25:Suppl 4. S19–S29.

8. Mori Y, Matsuo S, Sutoh H, Toriyama T, Kawahara H, Hotta N. A case of a dialysis patient with sclerosing peritonitis successfully treated with corticosteroid therapy alone. Am J Kidney Dis. 1997; 30:275–278.

9. Messina M, Ariaudo C, Mella A, Cantaluppi V, Segoloni GP, Biancone L. mTOR inhibitors for medical treatment of post-transplantation encapsulating peritoneal sclerosis: a favourable single center experience. J Nephrol. 2015; 28:245–249.

10. Huddam B, Azak A, Kocak G, Başaran M, Voyvoda N, Duranay M. Additive effectiveness of everolimus plus tamoxifen therapy in treatment of encapsulating peritoneal sclerosis. Ren Fail. 2012; 34:387–389.