Peritoneal encapsulation: a rare cause of small bowel obstruction

Abstract

Peritoneal encapsulation syndrome (PES) is a rare cause of small bowel obstruction (SBO) in patients with no prior history of abdominal surgery. First described by Cleland in 1868, PES is a congenital condition characterised by small bowel encasement in an accessory, but otherwise normal peritoneal membrane. 1 2 A result of abnormal rotation of the midgut during early development, the condition causes fibrous encapsulation of the intestines, thus preventing bowel distention.3 While preoperative diagnosis is difficult, several case reports have described clinical and imaging signs that can help clinicians with not only recognising the condition but also preparing appropriately for perioperative discovery of anatomical variants. 3 4

Congenital peritoneal encapsulation—a rare entity presented with small bowel obstruction

“…It develops during the 12fth week of embryological development when there is an abnormal return of the physiological umbilical hernia, containing the midgut, to the peritoneal cavity [ 5 ]. It was first described by Cleland in 1868 [ 6 ], with fewer than 50 cases described in the literature [ 1 , 7 ], the diagnosis of most cases being accidental. It occurs more frequently in young male patients and may be associated with intestinal malrotation [ 1 , 4 ].…”

“…While mostly asymptomatic, there is reference to repeated episodes of abdominal pain or intestinal obstruction [ 1–3 ]. In cases associated with small bowel obstruction, two signs suggestive of the disease have been described [ 7 , 8 ]: (i) asymmetric and permanent distention of the abdomen, which does not vary with peristaltic activity, and (ii) different consistency of the abdominal wall on palpation.…”

“…Surgical treatment involves excision of the peritoneal membrane and lysis of adhesions from its fixation points, since the bowel loops within the capsule lie freely without adherence to each other [ 1 , 2 , 5 , 7 ]. Histological examination of the membrane reveals normal peritoneum with fibrovascular tissue covered by mesothelium, without inflammation [ 1 , 4 , 7 ]. Intestinal resection is reserved for situations in which an atraumatic excision of the membrane is not possible or in the presence of intestinal ischemia.…”

“…Intestinal resection is reserved for situations in which an atraumatic excision of the membrane is not possible or in the presence of intestinal ischemia. The recognition and better understanding of this entity has currently allowed a laparoscopic approach [ 1 , 7 ]. The concomitant performance of appendectomy was due to the presence of intestinal malrotation, to avoid future diagnostic doubts in the face of abdominal pain.…”

“…SEP was first described by Owtschinnkow in 1907 [ 1–3 , 7 ], initially termed ‘peritonitis chronica fibrosa incapsulata’. This is an acquired condition associated with chronic peritoneal dialysis, recurrent peritonitis, ventriculoperitoneal/peritoneovenous shunts, sarcoidosis, tuberculosis, Mediterranean fever, protein-S-deficiency, liver transplantation, systemic lupus erythematosus and fibrogenic foreign bodies [ 1 , 4 ].…”