Accidental identification of peritoneal encapsulation during an autopsy after a car accident

Peritoneal encapsulation is a rare congenital pathological condition. Typical of this pathology is the presence of an accessory peritoneal flap that encloses the entire mass of the small intestine. Subjects with this condition often do not show symptoms and, in most cases, finding of it is accidental. We report a case of peritoneal encapsulation, not previously identified and found during an autopsy; the deceased, positive for HIV and affected by a Kaposi’s sarcoma, died following a road accident. Unlike other cases in the literature, the peritoneum encapsulated all abdominal organs and not only small intestines. Notwithstanding, there were no signs of intestinal ischaemia or intestinal obstruction.

Upper gastrointestinal surgery

This chapter outlines the assessment and management of the patient who presents with dysphagia, haematemesis and upper gastrointestinal perforation. The conditions commonly affecting the oesophagus, stomach, duodenum, jejunum and ileum are described; oesophageal motility disorders, pharyngeal pouch, hiatus hernia, gastro-oesphageal reflux disease, oesophageal tumours, peptic ulcer disease, gastric tumours, chronic intestinal ischaemia and small bowel tumours. Procedures such as upper gastrointestinal endoscopy and surgery for morbid obesity are also discussed in this chapter.

A Case of Colonic Ischaemia Masquerading as a Colonic Mass

Intestinal ischaemia is an uncommon vascular syndrome resulting from an acute or chronic drop in blood supply to the bowel, with varied clinical presentations. Intestinal ischaemia can present similarly to other conditions, leaving the clinician with a diagnostic dilemma. In this case report, we present a 69-year-old male who presented with abdominal pain, distention, anorexia and per rectal bleeding. Endoscopy showed a left-sided mass-like, ulcerated lesion, endoscopically thought to be colonic carcinoma. Histology later revealed this mass to be intestinal ischaemia, with no features of invasive carcinoma. This was confirmed at an interval endoscopy, which showed a largely healed mucosa and nil evidence of a mass. Raising awareness of this disease and its ability to mimic other presentations, both clinically and endoscopically, is key to establishing an early diagnosis and intervention.