The Helix Sign in the Peritoneal Encapsulation Syndrome: a New Sign in a Rare Cause of Bowel Obstruction?

Abstract

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Peritoneal encapsulation: a rare cause of small bowel obstruction

“…Conventional radiographs are typically consistent with bowel obstruction, as are CT images. Mitrousias et al believe preoperative diagnosis of this condition is aided by identification of a ‘helix sign’ on CT scan in which the loops of bowel are visualised in a pinwheel-type pattern 4…”

“…Histological analysis of the excised sac can be performed to confirm the diagnosis or to exclude any concerning pathologies, if necessary. Laparotomy has been the mainstay of treatment for this condition, though a laparoscopic approach may be possible if the condition is properly diagnosed preoperatively 4. While overall prognosis of PES is excellent and recurrence has yet to be described, it should not be considered a harmless condition.…”

“…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 of the small intestine: A rare case report

“…Preoperative diagnosis of PE may be impossible [1] since the radiological findings are usually normal or non-specific in case of intestinal obstruction [1] , [2] like in the presented case. Nevertheless, X-ray, ultrasonography, CT of the abdomen and barium study may contribute to preoperative diagnosis of PE [8] , [10] , [12] , [13] .…”

Abdominal cocoon: An enigmatic entity

“…In peritoneal encapsulation CT scan may reveal helical pattern of small bowel loops displaced anteriorly suggestive of "Helix sign" helpful in identifying peritoneal encapsulation as a differential of EPS. 50 Magnetic resonance imaging (MRI) has been recently reported as another useful modality in diagnosing EPS. The authors noted no significant difference between MRI and CT, moreover encasing membrane was more obvious in MRI with definite advantage of no exposure to ionizing radiation.…”