A Rare Cause of Small Bowel Obstruction: Congenital Peritoneal Encapsulation

Abstract

Congenital peritoneal encapsulation (CPE) is a rare condition in which part or all of the small intestine is surrounded by an accessory peritoneal layer congenitally. Although it rarely causes small bowel obstruction, it is usually asymptomatic and the diagnosis is mostly made incidentally during surgery or autopsy. A 41-year-old male patient presented to the emergency department with diffuse and cramping pain lasting for approximately 8 hours. He had nausea and vomiting. No gas or faeces output for 72 hours. Abdominal computed tomography (CT) showed dilated abdominal small intestines and findings consistent with obstruction. The patient was hospitalized with the diagnosis of ileus. Decompression was performed with a nasogastric tube. It was decided to perform diagnostic laparoscopic surgery for the patient who did not respond to 24-hour observation and medical treatment. Laparoscopic examination revealed a thin membrane covering the small intestine from the terminal ileum to the middle of the jejunal segment on the right side of the abdomen. All adhesions were separated, the small intestines were released from the pressure of the accessory peritoneum and placed in the abdomen. The patient was discharged without complications on the 6th postoperative day. CPE should be considered in small bowel obstructions of unexplained etiology. Laparoscopic evaluation is effective in diagnosing CPE, but in cases where the long small bowel segment is affected, as in our case, we think that it would be appropriate to switch to open surgery to prevent morbidity, as well as the necessity of separating all bands