Case Report
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World J Gastroenterol. Jul 21, 2013; 19(27): 4409-4412
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4409
Late post liver transplant protein losing enteropathy: Rare complication of incisional hernia
Jonathan D Evans, M Thamara PR Perera, CY Pal, James Neuberger, Darius F Mirza
Jonathan D Evans, M Thamara PR Perera, CY Pal, James Neuberger, Darius F Mirza, The Liver Unit, The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom
Author contributions: Evans JD performed a literature review and wrote the manuscript; Perera MTPR, Pal CY, Neuberger J, Mirza DF provided the intellectual content, undertook revisions and approved the final manuscript.
Correspondence to: Darius F Mirza, FRCS, Consultant Transplant Surgeon, Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom. darius.mirza@uhb.nhs.uk
Telephone: +44-121-4141833 Fax: +44-121-3716188
Received: January 7, 2013
Revised: March 15, 2013
Accepted: April 10, 2013
Published online: July 21, 2013
Processing time: 196 Days and 21.7 Hours
Abstract

Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.

Keywords: Protein losing enteropathies; Bacterial overgrowth; Hypoproteinaemia; Incarcerated hernia; Liver transplantation.

Core tip: This report presents a rare case of protein losing enteropathy as a result of bacterial overgrowth in the blind loop of an incisional hernia following liver transplantation. Surgical repair of the incisional hernia in this case brought about resolution of protein loss.