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Available from: URL: http://www.jgld.ro/2015/2/7/html
DOI: http://dx.doi.org/10.15403/jgld.2014.1121.242.hlx
The Helix Sign in the Peritoneal Encapsulation Syndrome: a New
Sign in a Rare Cause of Bowel Obstruction?
Vasileios Mitrousias1, Evangelos Alexiou2, Apostolos Katsanas1, Konstantinos Batzalexis1, Stylianos Germanos1
1) Department of Surgery; 2) Department of Radiology, General Hospital of Larissa Koutlimbanio & Triantafylio, Larissa, Greece
A 78-year-old male was referred to the emergency
department with three-day history of bilious vomiting and
abdominal pain and no previous abdominal surgery.
The initial clinical examination revealed abdominal
tenderness with mild distension without peritoneal signs.
Abdominal X-ray was indicative of small bowel obstruction.
No significant changes were found in the blood tests. A CT
scan revealed a mild small bowel dilatation with no discrete
transition point and a membranous, thin septum which
seemed to surround the small intestine resembling a thickened
accessory peritoneal sac (Fig.1). The 3D volume rendered images
illustrated a helical-pattern mass of small bowel loops displaced
anteriorly (Fig.2).
An explorative laparotomy under spinal anesthesia was
performed. The laparotomy revealed a thin, fibrous peritoneal
sac, with the borders extending from the level of the mesocolic
root superiorly, up to the level of the urinary bladder inferiorly
and between the ascending and the descending colon, laterally. A
small bowel loop was trapped into a small perforation of the sack
causing bowel obstruction (Fig.3). The sac was partially excised.
A sac encasing the small intestine is a rare condition, which
may remain asymptomatic [1, 2] or manifest as a small bowel
obstruction [3, 4]. Its cause is congenital, the result of the
abnormal rotation of the mid gut loop to the abdominal cavity
in the early stages of development [3]. There are no specific
CT findings described so far [1]. Therefore, we believe that the
helix sign in the appearance of the small intestine may well be
suggestive of the presence of peritoneal encapsulation. This sign
could raise the clinical awareness of this rare condition and could
be beneficial: an early diagnosis could replace open laparotomy
with laparoscopy.
Corresponding author: Vasileios Mitrousias;
vasileiosmitrousias@gmail.com
Conflicts of interest: None to declare.
References
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Ceylon Med J 2009; 54: 17-18. doi: 10.4038/cmj.v54i1.468
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J Gastrointestin Liver Dis, June 2015 Vol. 24 No 2: 144