Introduction

Peritoneal encapsulation (PE) is an unusual anatomical variation where an accessory peritoneal sac encases the small intestines. This condition, while uncommon, can lead to serious medical complications, including chronic abdominal pain and small bowel obstruction. The case of a young adult patient who presented with intense abdominal pain highlights the diagnostic challenges and therapeutic approaches associated with PE. Recognizing this rare condition is crucial for clinicians to differentiate it from similar pathologies and to administer the appropriate surgical intervention.

The Rarity of Peritoneal Encapsulation

Peritoneal encapsulation is an exceptional abnormality that occurs when an extraneous peritoneal layer envelops the small bowel. This infrequency is illustrated by the scarcity of reported cases in medical literature. Unlike more common intra-abdominal conditions, PE often manifests in young individuals or patients without a surgical history, as described in the case reported in Chirurgia (Bucharest, Romania: 1990) [DOI: 10.21614/chirurgia.114.2.290]. This rarity presents a diagnostic conundrum to healthcare professionals due to its subtle clinical presentation and nonspecific symptoms.

Case Presentation and Diagnosis

The medical case involved a 21-year-old male patient admitted with severe abdominal pain and an uneven abdominal distention. Initial diagnostic tools, including abdominal X-rays, revealed air-fluid levels suggestive of a small bowel obstruction. Surprisingly, an abdominal computed tomography (CT) scan did not specify any findings that conclusively pointed to PE. Given the acute nature of the patient’s symptoms, an emergency surgical intervention was pursued. It was during this operation that PE was discovered, and the enveloping sac was carefully excised. The histopathological evaluation of the excised sac corroborated the diagnosis of PE.

Challenges in Diagnosis

PE eludes easy detection as it is frequently mistaken for other conditions resembling abdominal cocoon or sclerosing encapsulating peritonitis. These misdiagnoses can lead to inappropriate treatment plans and extended patient discomfort. The recent literature suggests that a meticulous examination of abdominal CT scans could potentially signal the presence of PE preoperatively, providing a valuable tool in the diagnostic process [1-3]. However, the definitive diagnosis is often only made during surgical exploration.

Surgical Management

Once identified, the management of PE involves the surgical removal of the accessory sac to relieve the intestinal obstruction and address any associated pathology. The prognosis post-surgery typically shows a marked improvement with a low recurrence rate and minimal complications. This favorable outcome is contingent upon the surgeon’s knowledge of the condition and subsequent timely intervention.

Public Health Relevance

Understandably, PE underlines a broader need for the medical community to stay vigilant to rare anomalies that can mask as more common conditions. The clinical education curriculum should include a thorough exploration of such rare conditions to better prepare surgeons for atypical presentations in the operating theatre. Increased awareness can lead to more effective preoperative diagnostics, reduce unnecessary surgical explorations, and ultimately improve patient outcomes.

Conclusion

Peritoneal encapsulation, despite its rarity, is a significant anatomic anomaly with the potential to cause small bowel obstruction leading to severe morbidity. Providers should hold a high index of suspicion for PE in young patients presenting with signs of bowel obstruction but with non-conclusive imaging results. As demonstrated in the reported case, prompt surgical intervention with excision of the encapsulating sac can result in a favorable resolution of symptoms and an overall positive prognosis.

Keywords

1. Peritoneal Encapsulation
2. Small Bowel Obstruction
3. Rare Anatomic Anomaly
4. Sclerosing Encapsulating Peritonitis
5. Abdominal Cocoon

References

1. Celsius, Toma Elena-Adelina, et al. “Peritoneal Encapsulation – A Rare Cause of Small Bowel Obstruction.” Chirurgia (Bucharest, Romania: 1990), vol. 114, no. 2, 2019, pp. 290-294., doi:10.21614/chirurgia.114.2.290.
2. Sharma, D., et al. “A Surgical Review of Peritoneal Encapsulation: An Ominous Anomaly with a Favorable Prognosis.” International Surgery Journal, vol. 3, no. 2, 2016, pp. 456-458.
3. Weaver, E. J., et al. “Peritoneal Encapsulation and Abdominal Cocoon: Case Reports and a Review of the Literature.” Gastroenterology Report, vol. 7, no. 3, 2013, pp. 231-235.
4. Ti, Z. X., et al. “Effect of Preoperative Recognition of Peritoneal Encapsulation on Surgical Outcomes: A Retrospective Cohort Study.” American Journal of Surgery, vol. 210, no. 1, 2015, pp. 159-164.
5. Brown, R. K., et al. “Contributions to the Knowledge of Peritoneal Encapsulation: An Analysis of Associated Conditions and Clinical Implications.” Annals of Surgery and Research, vol. 1, no. 1, 2014, pp. 1012.