case_images: PMC9580079_01
case_images: CT showing the duodenum (D3) anterior to the superior mesenteric artery.
case_images: 10.1177_2050313X221132436-fig1.jpg
case_images: PMC9580079_01_10.1177_2050313X221132436-fig1.jpg
case_images: fig1-2050313X221132436
case_images: CT of the abdomen and pelvis revealed the duodenum anterior to the SMA, swirling consistent with a partial mesenteric volvulus, an occlusive thrombus in the SMV extending to the portal confluence, and no evidence for a bowel obstruction (Figure 1).
case_images: Accessory peritoneal membrane (black arrows).
case_images: 10.1177_2050313X221132436-fig2.jpg
case_images: PMC9580079_01_10.1177_2050313X221132436-fig2.jpg
case_images: fig2-2050313X221132436
case_images: On opening the peritoneal cavity, the entire small bowel was found to be encased in an accessory thin transparent sac without associated adhesions (Figure 2).
case_images: Surgeon's hand connecting with DeBakey forceps through a defect posterior to the SMV and mesentery.
case_images: 10.1177_2050313X221132436-fig3.jpg
case_images: PMC9580079_01_10.1177_2050313X221132436-fig3.jpg
case_images: fig3-2050313X221132436
case_images: Treitz was in the normal anatomic position, the duodenum was anterior to the superior mesenteric vessels, the 2 cm in diameter SMV was filled with clot, and the distal ileum passed posterior to the SMV and mesentery via a congenital defect prior to entering the cecum (Figure 3). The entire accessory peritoneal sac was excised and sent to pathology.
case_images: Accessory peritoneal membrane surrounding the small bowel.
case_images: 10.1177_2050313X221132436-fig4.jpg
case_images: PMC9580079_01_10.1177_2050313X221132436-fig4.jpg
case_images: fig4-2050313X221132436
case_images: Retrospective review of the patient's imaging with radiology confirmed the accessory peritoneal membrane surrounding the small bowel consistent with CPE (Figure 4).