Peritoneal encapsulation as a cause of chronic recurrent abdominal pain in a young male

Congenital Peritoneal Encapsulation: A Review

Congenital peritoneal encapsulation (CPE), a rare developmental anomaly in which the small intestines are enclosed within an accessory peritoneal sac, is an uncommon but important cause of abdominal pain and small bowel obstruction. With fewer than 60 reported cases, the demographics, imaging findings, and symptoms of CPE remain elusive, as most cases are diagnosed intraoperatively during treatment for bowel obstruction. We report a case of a 34-year-old male with no significant medical history who presented with acute abdominal pain and nausea. He was hemodynamically stable and afebrile, and CT imaging indicated a possible small bowel obstruction. Surgical intervention was required when his condition worsened, with large-volume emesis following oral contrast administration during a small bowel follow-through study. Explorative laparotomy revealed a peritoneal encapsulation of the entire small bowel as the cause of obstruction. Complete removal of the membrane was performed, and histopathology confirmed findings consistent with an intraperitoneal sac with reactive changes, supporting the diagnosis of CPE. This review highlights the challenges in diagnosing CPE due to its lack of associated comorbidities, minimal symptoms, and nonspecific imaging findings. A detailed discussion of 21 recent cases of CPE emphasizes patient demographics, presentation history, imaging, physical exam, intraoperative findings, and surgical management. This modern analysis underscores the importance of considering CPE in the differential diagnosis for unexplained abdominal pain or bowel obstruction, particularly when conventional diagnostic methods fail to identify a cause.

Congenital Peritoneal Encapsulation: A Literature Review of a Rare Pathology

Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which an accessory peritoneal membrane surrounds the small bowel. This condition is usually asymptomatic and rarely causes intestinal obstruction. Despite the rare cause of intestinal obstruction, it has excellent post-operative recovery. There is no gold standard approach for investigating CPE; however, a computerized tomography scan of the abdomen might be helpful. Furthermore, diagnostic laparoscopy could be considered an adjunct. This report highlights the rare congenital anomaly as a cause of intestinal obstruction.

Congenital peritoneal encapsulation and superior mesenteric vein thrombosis: A case report

Congenital peritoneal encapsulation is a rare entity characterized by an accessory peritoneal membrane that forms during embryonic development. Congenital peritoneal encapsulation is generally asymptomatic but can cause intermittent, colicky abdominal pain related to subacute small bowel obstruction. Diagnosis is made incidentally or upon surgical exploration for chronic abdominal complaints as preoperative imaging is typically nonspecific. We report a case of a 49-year-old male with epigastric abdominal pain, constipation, and superior mesenteric vein thrombosis on imaging. Upon exploratory laparotomy, the small bowel was covered by an accessory peritoneal sac consistent with congenital peritoneal encapsulation. The accessory sac was excised completely, and the patient recovered well. Although rarely causing significant gastrointestinal symptoms, congenital peritoneal encapsulation is an anomaly that requires surgical intervention.

Accidental identification of peritoneal encapsulation during an autopsy after a car accident

Peritoneal encapsulation is a rare congenital pathological condition. Typical of this pathology is the presence of an accessory peritoneal flap that encloses the entire mass of the small intestine. Subjects with this condition often do not show symptoms and, in most cases, finding of it is accidental. We report a case of peritoneal encapsulation, not previously identified and found during an autopsy; the deceased, positive for HIV and affected by a Kaposi's sarcoma, died following a road accident. Unlike other cases in the literature, the peritoneum encapsulated all abdominal organs and not only small intestines. Notwithstanding, there were no signs of intestinal ischaemia or intestinal obstruction.

Withdrawal: Torsello A, et al. Congenital Peritoneal Encapsulation and Nephrotic Syndrome. J Forensic Sci 2020 (https://onlinelibrary.wiley.com/doi/10.1111/1556-4029.14292)

The above article, published online on January 27, 2020, in Wiley Online Library, has been withdrawn by agreement between the authors, the JFS Editor in Chief (Dr. Michael Peat), and John Wiley & Sons Ltd. The withdrawal has been agreed by all parties given the ongoing confidential legal proceeding concerning the death of the individual included in the Case Report.

Congenital peritoneal encapsulation: A review and novel classification system

Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood, underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the diagnosis. Management of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and adhesiolysis. Prognosis following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.

Peritoneal encapsulation: a rare cause of small bowel obstruction

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}.