Chronic peritonitic encapsulation of the small intestine due to tuberculosis with prolonged high jejunal obstruction.

PERITONEAL ENCAPSULATION of the small intestine is an anomaly in which the whole small intestine is found in the mid-abdomen inside a large sac of normal peritoneum (Lewin and McCarthy 1970). Lewin and McCarthy described in their case a small non-constricting aperture in the sac in the lower right quadrant of the abdomen from which the terminal ileum emerged. Superiorly the sac enclosed the duodeno-jejunal junction. Hardas (1970) reported a case associated with malposition of the gut. Chronic peritonitic encapsulation is a different disorder in which a globular or ovoid sac encloses the small intestine, but the membrane is thick, though not adherent to the surface of the small intestine loops, which themselves are aggregated, and adherent to each other. Presumably this may rarely be the result of chronic peritonitis in a patient with congenital peritoneal encapsulation, but it may more usually be the consequence of the laying down of an inflammatory membrane on the surface of a hitherto normal small intestine. In either case it may be tuberculous, but in many cases no aetiology can be determined. Albot et al (1970) have described a case in which jejuno-ileitis of unknown origin led over six years to encapsulating peritonitis with high jejunal obstruction and death. There was no histological evidence of Crohn's disease, nor any of tuberculosis. Albot's case was explored in the second year and the peritonitis was seen in the more acute stage when there was not yet a capsule. Pezzi (1967) described two cases of encapsulating peritonitis with high jejunal obstruction. Both were explored and both survived. There was no histological evidence of any particular disease. However negative histology may not necessarily exclude tuberculosis.