Congenital peritoneal encapsulation presented with small bowel obstruction

Abstract

Background: Congenital peritoneal encapsulation is an extremely rare condition with an etiology based on abnormal embryonic gastrointestinal development. It is characterized by congenital development of an accessory peritoneal layer partially or entirely encapsulating the small bowel. The condition is poorly understood and often discovered incidentally, either intra-operatively or during autopsy. The majority of cases are asymptomatic and rarely complicated by small bowel obstruction. The preoperative diagnosis may be impossible by plain radiographs, which are often normal or may show signs of small bowel obstruction. Computed tomography (CT) may be helpful in preoperative diagnosis of congenital peritoneal encapsulation in a patient with obstruction. Case presentation: We report a case of a 46-year-old male patient, who presented with features of intestinal obstruction; surprisingly, CT accurately suggested the diagnosis of peritoneal encapsulation which was confirmed at surgery. Conclusions: The presence of physical signs such as asymmetrical and fixed abdominal distension can help the clinician to raise the suspicion of peritoneal encapsulation; however, CT in the right settings can confirm the diagnosis.

Chronic constipation and acute small bowel obstruction due to small bowel encapsulation: A case report

“…Peritoneal encapsulation (PE) included three different conditions: congenital peritoneal encapsulation (CPE), abdominal cocoon (AC), and sclerosing encapsulating peritonitis (SEP). 7 Congenital peritoneal encapsulation (CPE) is a malformation of the gastrointestinal tract. It is specified by the accessory peritoneal membrane, which covers a variable extent of the small bowel.…”

“…The widely used theory of Papez illustrates CPE as an aberrant peritoneal adhesion between the linings of the physiological umbilical hernia and the caudal duodenum. 7,9 The peritoneum encapsulates the midgut within the cord, which results in a sac-like shape on the walls of the hernia. Therefore, the neck of this sac becomes close to the caudal duodenum.…”

“…15 In our case, similar to Abdallah Mohamed et al case study, CT was able to suggest intestinal encapsulation as the differential diagnosis of bowel obstruction before the operation. 7 The most challenges are in asymptomatic cases discovered during operation with another cause, especially in minimally invasive methods, and could be the source of confusion. So, more studies about the anatomy of these anomaly types are necessary.…”

“…[4][5][6] Congenital peritoneal encapsulation (CPE) is a congenitally scarce condition where the accessory peritoneal membrane is encapsulated the small bowel. 7 Other syndromes with small bowel encapsulation are abdominal cocoon syndrome (ACS) and sclerosing encapsulating peritonitis (SEP). The primary etiologies of both syndromes are idiopathic, and the second one is related to chronic peritoneal dialysis.…”

“…Rarely did the issues present with bowel obstruction signs and symptoms. 7 This article described a patient with small bowel obstruction and chronic constipation due to small bowel encapsulation.…”