Congenital peritoneal encapsulation complicated by closed-loop obstruction and bowel ischemia: a case report

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.