PMC9580079_01
CT showing the duodenum (D3) anterior to the superior mesenteric artery.
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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).
Accessory peritoneal membrane (black arrows).
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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).
Surgeon's hand connecting with DeBakey forceps through a defect posterior to the SMV and mesentery.
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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.
Accessory peritoneal membrane surrounding the small bowel.
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Retrospective review of the patient's imaging with radiology confirmed the accessory peritoneal membrane surrounding the small bowel consistent with CPE (Figure 4).