Peritoneal encapsulation with an abnormal vessel in a band causing small bowel obstruction: a rare entity

Peritoneal encapsulation: a rare cause of small bowel obstruction

“…A commonality among all patients with PES is intraoperative discovery of a sac morphologically similar to peritoneum encasing the small bowel, though some reports such as ours also describe an obstructive band and associated aberrant artery. In these reports, the band was divided to relieve the obstruction, and its associated vessel was observed to divide into two branches above the terminal ileum 19–21. Histological examination of the sac typically reveals mesothelium of peritoneal origin covering fibrovascular tissue 22…”

Peritoneal encapsulation – An unusual cause of acute bowel obstruction: A case report

“…Others have also described a variable consistency to palpation of the abdominal wall with areas not covered by the accessory peritoneal membrane being described as distended and soft and areas covered by the membrane as firm and flat [ 2 ]. CT can often be normal or only reveal distended loops of bowel [ 4 ]. Imaging may reveal an accessory peritoneal sac that encases dilated and clustered loops of bowel in a helical pattern resembling a cocoon [ 2 ].…”

“…However, imaging is neither sensitive nor specific for diagnosis of congenital PE and should only be used an adjunct. Management of obstruction secondary to PE requires emergency surgery, with excision of the accessory peritoneal sac and division of band adhesions; bowel resection may be necessary if the viability is threatened [ 4 ].…”

“…Congenital PE may remain undiagnosed in many people as it is usually asymptomatic. A literature search showed about 50 reported cases worldwide incidentally identified during surgery for unrelated conditions or autopsies [ 3 , 4 ]. In some cases, PE presents with small bowel obstruction due to abnormal kinking of the loops encased in the accessory peritoneum or by a congenital band or adhesion.…”