A Case of Congenital Peritoneal Encapsulation Complicated with Left Paraduodenal Hernia Presenting as Recurrent Small...

Congenital peritoneal encapsulation (CPE) is a rare anomaly in which the small intestine is enclosed in a thin peritoneal sac. Although mostly asymptomatic, CPE can cause severe intestinal obstruction due to strangulation and torsion.

A 16-year-old male patient had been experiencing recurrent intestinal obstruction of unknown cause since the age of 13. He was admitted with persistent abdominal pain as his chief complaint, and emergency laparoscopic surgery was performed due to a suspected strangulating intestinal obstruction. The findings included an abnormal course of the inferior mesenteric vein (IMV), severe intussusception of the small intestine into the descending mesentery, ileal adhesions, and a segment of the small intestine covered by a thin membrane. The patient was diagnosed with CPE and a left paraduodenal hernia. Initially, the hernia was treated with manual reduction, and CPE was managed by excising the accessory peritoneal membrane and performing adhesiolysis. However, recurrent obstruction occurred due to dense terminal ileal readhesion, necessitating a reoperation on the 21st POD. During reoperation, side-to-side strictureplasty was performed for the adhesion, and the paraduodenal hernia was definitively managed by unroofing the hernia sac. The patient recovered uneventfully, without recurrence.

Complex congenital anatomical abnormalities, such as CPE and internal hernias, should be considered in recurrent intestinal obstruction from childhood to young adulthood. If CPE is confirmed intraoperatively, investigation of other congenital anomalies is warranted, and the possibility of robust postoperative adhesions due to congenital fusion planes must be considered.