Congenital Peritoneal Encapsulation: A Review

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.