43-year-old with history of pain abdomen and vomiting for 1 day. On medication for H.pylori induced chronic gastritis.
HISTORY
- 43-year-old with a history of pain abdomen and vomiting for 1 day. On medication for H.pylori-induced chronic gastritis.
- Clusters of small bowel loops within large thin peritoneal sac (orange arrow) starting from the duodeno-jejunal junction to distal ileum which are mildly dilated and fecalized.
- Colon appear normal (green arrow).
- Mild mesenteric fat stranding and mild free fluid is seen in the sac.
- The inferior mesenteric vein (white arrow) is stretched posteriorly along the hernial sac.
- No evidence of small bowel ischemia.rit
- No evidence of lymphadenopathy or omental nodulay.
DIAGNOSIS:
- Congenital peritoneal encapsulation
DISCUSSION:
- Congenital peritoneal encapsulation is a rare congenital anomaly characterized by partial or total peritoneal encapsulation of the small bowel.
- Peritoneal encapsulation (PE) is a general term used to describe three different entities: congenital peritoneal encapsulation (CPE), abdominal cocoon (AC), and sclerosing encapsulating peritonitis (SEP)
- Abdominal cocoon and sclerosing encapsulating peritonitis are believed to be secondary to inflammatory etiology.
Intraoperative images showing capsule enacsaing the bowel loops on opening of the abdomen
(Pic courtesy: Dr Satish M and Dr Veeresh M, Department of surgery, Manipal Hospital)
DIFFERENTIALS
- Left paraduodenal hernia – a cluster of small bowel loops in the left anterior pararenal space and posterior to the descending colon, inferior mesenteric vein, and ascending left colic artery,
- Right paraduodenal hernia – posterior to the superior mesenteric vessels
REFERENCES
- Mohamed AA, Al Shuraiqi FM, Al Sarhani S, Al Busaidi SA, Joodi AA. Congenital peritoneal encapsulation presented with small bowel obstruction. Egyptian Journal of Radiology and Nuclear Medicine. 2020 Dec;51(1):1-4.
- Teixeira D, Costa V, Costa P, Alpoim C, Correia P. Congenital peritoneal encapsulation. World Journal of Gastrointestinal Surgery. 2015 Aug 27;7(8):174
Dr Praveen Wali
Consultant radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru
Dr Vikas H P
Radiology resident
Manipal Hospital, Yeshwanthpur, Bengaluru
Dr Sampath Kumar
Consultant radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru
