Innovative Approach to Pediatric Peutz-Jeghers Syndrome: Simultaneously Performing Laparoscopic Reduction of...

In patients with Peutz-Jeghers syndrome (PJS), repeated laparotomy and bowel resection can lead to short bowel syndrome and adhesions. Minimizing surgical invasiveness while effectively managing intussusception caused by polyps is therefore essential. We present a pediatric case of recurrent intussusception due to a jejunal polyp near the ligament of Treitz, successfully treated with a hybrid approach combining laparoscopic reduction and double-balloon enteroscopy (DBE)-assisted polypectomy.

A 9-year-old girl presented with small bowel intussusception and underwent laparoscopic-assisted resection of a 40-cm jejunal segment containing a 35-mm polyp and multiple adjacent polyps. Postoperative findings led to a diagnosis of PJS. Two weeks later, she developed recurrent intussusception. CT revealed a lead-point mass without signs of ischemia or strangulation. At reoperation, laparoscopic reduction was achieved except for residual intussusception near the ligament of Treitz. Under continuous laparoscopic observation, DBE identified a 40-mm polyp 30-40 cm distal to the pylorus. En bloc removal was not feasible; therefore, piecemeal resection was performed, resulting in complete release of the intussusception. Follow-up capsule endoscopy at 2 months confirmed no residual lesion.

This case highlights the feasibility and safety of a hybrid laparoscopic-endoscopic approach for intussusception caused by proximal small bowel polyps in PJS, allowing bowel preservation and effective lesion removal. This strategy may serve as a valuable treatment option in selected cases.