EP-325 Congenital peritoneal encapsulation rare pathology for Acute intestinal Obstruction

Abstract

Background Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which the small bowel is surrounded by an accessory peritoneal membrane. This condition is usually asymptomatic and rarely causes intestinal obstruction. This report highlights this rare congenital anomaly as a cause of intestinal obstruction. Case A 28-year-old fit man presented to A&E with classical features of intestinal obstruction. Abdominal CT scan showed features of mechanical small bowel with 360-degree rotated mesentery, and a suspicion of closed loop obstruction. An emergency laparotomy was performed. A large congenial peritoneal sac, wrapped the small bowel from D-J flexure to proximal part of ileum, and this sac was rotated 360 degrees with multiple adhesions and a single band to the left lateral wall. Early ischemic changes were noted, along with congested mesentery. The sac was opened, dissected and adhesiolysis was performed. The thick solitary band was released. There was immediate restoration of the blood supply and the bowel was viable. Patient recovered and discharged home on day 3 Discussion and conclusion Worldwide, only 50 cases on CPE have been published till date, with the maximum reported from the UK. The other common conditions that mimic CPE are internal paradodenal hernia, abdominal cocoon and sclerosing encapsulating peritonitis. Young patients with abdominal pain and feature of closed loop high small bowel obstruction on CT scan will need a high index of suspicion, before confirming the diagnosis. At this point, it will remain a rare occurrence and an incidental finding at laparotomy.