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

Abstract

Congenital peritoneal encapsulation is a rare congenital malformation in which all or part of the small bowel is covered by a thin accessory peritoneal membrane. Despite being usually asymptomatic and an incidental finding during surgery or autopsy, there is a small number of reports in the literature whose diagnosis was established in the context of intestinal obstruction. The authors review the topic and describe a case report undergoing surgery for intestinal obstruction. Intraoperatively, there was a partial peritoneal encapsulation of the small bowel with signs of intestinal malrotation. Peritoneal membrane excision, terminal ileum release and complementary appendicectomy were performed. There was a favorable clinical evolution in the postoperative period. Although rare, it is important to remember this entity in the differential diagnosis of patients with intestinal obstruction, in the absence of other etiologic factors.

Keywords: intestinal malrotation; intestinal obstruction; peritoneal encapsulation.

Figure 1

Sagittal CT scan shows small bowel distension with air/fluid levels (arrows).

Figure 2

Coronal CT scan shows signs of intestinal malrotation, with alteration of the normal topography of the duodenal arch (arrow).

Figure 3

Axial CT scan shows retrocecal position of terminal ileum and free fluid in the right abdominal quadrants (arrows).

Figure 4

Peritoneal encapsulation of the small bowel at laparotomy.

Figure 5

After excision of the accessory peritoneal membrane, signs of intestinal malrotation with medialization of the right colon were noted (arrow).

Figure 6

Terminal ileum in a retrocecal position leading to intestinal obstruction (arrow).