Role of liver transplantation in severe alcoholic hepatitis

Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic hepatitis can become a viable rescue therapeutic option conferring significant survival advantage of both short- and long-term basis. The optimal criteria for selection will also prevent misuse of the liver donor pool as well as to prevent mortality in salvageable patients. Further research needs to be done to identify subset of patients which are at low risk of recidivism and also cannot be managed with pharmacotherapy alone. We reviewed the current knowledge on role of OLT in patient with acute severe alcoholic hepatitis in the present review.

Abdominal cocoon as a presenting feature of systemic lupus erythematosus. A rare presentation

Systemic lupus erythematosus [SLE] is a multi-organ disorder, which can involve any system of the body, single, or in combination. In the gastrointestinal tract, it can present as nausea, vomiting, abdominal pain, gastroesophageal reflux, dysphagia, constipation, diarrhea, fecal incontinence, intestinal pseudo-obstruction, perforation, and hemorrhage. Abdominal cocoon or sclerosing-encapsulated peritonitis is a rare cause of intestinal obstruction, resulting from the encasement of variable lengths of bowel by a dense fibrocollagenous membrane that gives the appearance of a cocoon. It is often seen in adolescent girls. We hereby present a case of abdominal cocoon with repeated vomiting and subacute intestinal obstruction as presenting features of SLE in a young girl. The abdominal features responded well to steroids and immunosuppressive therapy