Endoscopic Treatment of Colo-Colonic Intussusception in a Patient with Peutz-Jeghers Syndrome

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Medical Genetics

Background:

• Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by hamartomatous polyps in the gastrointestinal tract.
• PJS increases the risk of various cancers, including colorectal cancer.
• Intussusception is a known complication of PJS, particularly in the small bowel.

Observation:

• A 19-year-old male with PJS and prior small bowel resections presented with lower abdominal pain.
• CT imaging revealed concentric, multilayered, and cord-like structures in the transverse colon, suggestive of colo-colonic intussusception.
• Initial attempts at therapeutic enemas were unsuccessful in reducing the intussusception.

Findings:

• Colonoscopy successfully reduced the intussusception.
• A large (40 mm) transverse colon polyp with a thick stalk was identified and resected.
• Histopathological analysis confirmed the polyp's nature, likely related to PJS.

Implications:

• Large PJS polyps (>30 mm) in the transverse or sigmoid colon are identified as a significant risk factor for intussusception.
• Endoscopic management of such large polyps should be strongly considered to prevent complications like intussusception.
• This case highlights the importance of vigilant monitoring and timely endoscopic intervention in PJS patients to manage polyp-related risks.