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Minimally invasive treatment of congenital peritoneal encapsulation: a case report

Congenital peritoneal encapsulation (CPE) is a rare condition arising from an embryological abnormal development of the midgut and hindgut, leading to an accessory peritoneal sac which can partially or totally cover the small intestine. This pathology is mostly asymptomatic and is accidentally found during surgical procedures undertaken for other reasons. However, CPE can cause occasionally small bowel occlusion and might be associated to other abnormalities of the digestive tract, such as vascular mesenteric malformations or incomplete situs inversus and epigastric hernia. The pre-operative diagnosis can be extremely challenging, since in the majority of cases there are no pathognomonic clinical signs. In fact, computer tomography is able to detect only indirect CPE findings. This pathology has been reported only in a few cases in the literature and the treatment involved always an open surgical approach. In the current report we describe the case of a patient undergoing surgery for a diverticular colonic stenosis, in which CPE was an incidental intraoperative finding. Hereby we report the first case in the literature of CPE successfully treated with laparoscopy. During the procedure the entire membrane was easily removed and there were no perioperative complications. We believe that the minimally invasive approach for patients presenting CPE is safe and feasible and should be preferred to open surgery.