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Laparoscopic management of small bowel intussusception in a 16-year-old with Peutz-Jeghers syndrome
Angel Mario Morales Gonzalez1, Benjamin Clapp
1Texas Tech University Health Sciences Center at El Paso, Department of Surgery, El Paso, Texas 79912, USA. Angel.Morales@ttuhsc.edu
Insights
Peutz-Jeghers syndrome patients experiencing bowel obstruction can be successfully treated with minimally invasive surgery. Prompt removal of the hamartomatous polyp causing the intussusception is crucial for recovery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Genetics
Background:
- Peutz-Jeghers syndrome is a rare autosomal dominant disorder.
- Characterized by hamartomatous polyps and mucosal discoloration.
- Polyps can cause gastrointestinal complications like bowel obstruction.
Observation:
- A 16-year-old male with Peutz-Jeghers syndrome presented with acute bowel obstruction.
- Symptoms included abdominal pain, obstipation, and vomiting.
- History of colonoscopy with polypectomy and characteristic hyperpigmentation.
Findings:
- CT scan revealed small intestine intussusception.
- Laparoscopic surgery identified a jejunal intussusception.
- A 5-cm polyp was the lead point; resection was performed.
- Additional polyps found in the stomach and colon were removed.
Implications:
- Minimally invasive approaches are effective for small bowel obstruction in Peutz-Jeghers syndrome.
- Surgical management involves removing the causative hamartomatous polyp.
- Comprehensive intraoperative examination and polypectomy are essential.
- Laparoscopic-assisted enteroscopy and colonoscopy facilitate complete polyp removal.
Introduction:
Peutz-Jeghers is a rare autosomal dominant disorder characterized by hamartomatous polyps and discoloration of mucosal membranes. The polyps can occur anywhere in the gastrointestinal tract and can grow large enough to cause bowel obstructions.
Case Report:
A 16-year-old male presented to the emergency department with signs and symptoms of an acute bowel obstruction. He had 2 days of abdominal pain, obstipation, and vomiting. He had a previous history of a colonoscopy with polypectomy at age 4, and hyperpigmentation of his mucous membranes.
Results:
Computed tomographic (CT) scan revealed an intussusception of the small intestine. An exploratory laparoscopy found an intussusception of the mid jejunum. A laparoscopic-assisted small bowel resection was performed. Pathology showed a 5-cm polyp that acted as a lead point for the intussusception. Colonoscopy and upper endoscopy revealed 5 more polyps in the stomach and colon that were removed.
Conclusion:
Small bowel obstructions can be managed successfully with minimally invasive approaches. The treatment of obstruction in these patients is to remove the offending hamartomatous polyp(s). The rest of the intestine needs to be examined and those polyps found should be removed. This can be done intraoperatively with laparoscopic-assisted enteroscopy and colonoscopy.
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