Peritoneal encapsulation, left paraduodenal hernia with retroperitonealization of inferior mesenteric vein leading to triple obstruction

Abstract

Encasing of small bowel in an anomalous accessory membrane results in peritoneal encapsulation and is a very rare cause of intestinal obstruction. It is believed to be caused by malrotation of the bowel during the 12th week of gestation and this causes the formation of an accessory sac from the peritoneum, covering the umbilicus. Left paraduodenal hernia is the most common form of congenital internal hernia. Paraduodenal hernia are caused by abnormal rotation of the midgut during embryonic development. This rarely presents as an intestinal obstruction. Congenital adhesions are rare in adults and these may lead to retroperitonealization of inferior mesenteric vein (IMV). A case of peritoneal encapsulation and left paraduodenal hernia with congenital adhesions leading to retroperitonealization of inferior mesenteric vein (IMV) in the same patient is reported here. A 28-year-old male presented with recurrent small bowel obstruction and was diagnosed with an intestinal obstruction. Computed tomography confirmed peritoneal encapsulation and left paraduodenal hernia with features of intestinal obstruction. Excision of membrane and reduction of hernia with retroperitonealization of inferior mesenteric vein was done. This is the first case reported in literature where peritoneal encapsulation, paraduodenal hernia and retroperitonealization of inferior mesenteric vein (IMV) occurred together and lead to bowel obstruction. In this case, the origin of three abnormal anatomical structures must have been congenital as there was no history of prior surgery.