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Role of Laparoscopy in Severe Gastrointestinal Bleeding Secondary to Coats Plus Syndrome
Miguel Serpa-Irizarry1, Pedro Ruiz-Medina2, Antonio Del Valle-Segarra3
1General Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI.
Insights
Coats plus syndrome (CPS) causes severe gastrointestinal bleeding. Laparoscopic assisted enteroscopy with enterectomy successfully diagnosed and treated a patient with CPS when standard endoscopy failed.
Area of Science:
- Genetics
- Gastroenterology
- Ophthalmology
Background:
- Coats plus syndrome (CPS) is a rare genetic disorder linked to premature telomere shortening.
- CPS presents with multisystemic manifestations including cerebroretinal microangiopathy, growth deficiency, and osteopenia.
- Recurrent gastrointestinal (GI) bleeding affects up to 40% of individuals with CPS, posing life-threatening risks.
Observation:
- A 20-year-old female with CPS experienced two years of severe, recurrent GI bleeding.
- Conventional endoscopic methods failed to identify the source of bleeding.
- The patient's condition necessitated advanced diagnostic and therapeutic interventions.
Findings:
- Laparoscopic assisted enteroscopy was employed for diagnosis.
- Surgical intervention via enterectomy was performed.
- This combined approach successfully identified and treated the source of GI bleeding.
Implications:
- Laparoscopic assisted enteroscopy with enterectomy represents a novel and effective modality for managing complex GI bleeding in CPS patients.
- This case underscores the importance of considering advanced endoscopic techniques for rare genetic disorders with challenging symptoms.
- Successful treatment offers a potential pathway for improved patient outcomes in similar complex cases.
Abstract:
Coats plus syndrome (CPS) is an exceedingly rare genetic disorder associated with premature telomere shortening. The syndrome, also known as cerebroretinal microangiopathy with calcifications and cysts, has a multisystemic manifestation. It may present as brain abnormalities, seizures, osteopenia, prenatal and postnatal growth deficiency, and portal hypertension, among others. Up to 40% of affected individuals manifest recurrent gastrointestinal (GI) bleeding which can be life-threatening in some cases. Treatment for GI bleeding is not standardized and is therefore individualized based on the patient's clinical status, comorbidities, and resource availability. We herein present a case of a 20-year-old female with CPS and a two-year history of severe recurrent GI bleeding unable to be identified by conventional endoscopy. This report highlights successful laparoscopic assisted enteroscopy with enterectomy as a novel diagnostic and therapeutic modality in this population.
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