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 (CPE) is a rare developmental anomaly characterized by an accessory peritoneal membrane surrounding the small bowel. Most cases are asymptomatic or present with intermittent abdominal pain. While CPE has been associated with bowel obstruction in rare instances, bowel ischemia requiring resection has not been reported. We present a unique case of CPE complicated by closed-loop obstruction and bowel ischemia. A woman in her late 60s with a history of hypertension and type 2 diabetes mellitus presented with a 10-day history of colicky abdominal pain, vomiting, and constipation. She reported recurrent abdominal pain since childhood, worsening over the past decade. Abdominal examination revealed a left lower quadrant mass. Imaging suggested a closed-loop small bowel obstruction. During exploratory laparotomy, a thick peritoneal membrane encapsulating the small bowel was identified. Bowel ischemia was noted, necessitating resection of a 15 cm ileal segment with anastomosis. Histopathology confirmed a stenotic fibrous band with mild serositis. The patient had an uneventful recovery, with complete resolution of symptoms. CPE is often misdiagnosed due to its rarity and non-specific presentation. This case uniquely shows its potential to cause bowel ischemia, an unreported complication. Surgeons should consider CPE in cases of unexplained bowel obstruction. Early recognition and surgical intervention are crucial in preventing severe complications such as ischemia.

Urgent investigation is crucial for infants with bilious vomiting, potentially indicating bowel obstruction. Upper gastrointestinal fluoroscopy aids diagnosis, but is not without its challenges. This case report describes a rare case of neonatal intestinal malrotation and mid-gut volvulus with an additional complication of congenital peritoneal encapsulation. This case study offers insights into associated diagnostic challenges and underscores the value of utilising fluoroscopy in diagnosing complex gastrointestinal conditions.

Peritoneal encapsulation (PE) is a rare congenital disorder described as an accessory peritoneal lining covering a part or whole of the small bowel. Some theorise the encapsulation is due to the formation of adhesion between the physiological hernia and the caudal duodenum. While others have stated it is a defect in the reduction of the physiological hernia. Patients usually present at different stages of intestinal obstruction at any point of time during life. There are also reports on post-humous diagnosis on autopsy. PE is a rare surgical entity, hence not much evidences are available on how to tackle this condition by minimally invasive approach. Here, we report a case of PE in a 43-year-old male who presented with features of intermittent sub-acute intestinal obstruction and was managed by laparoscopic surgery at our institute.