Laparoscopic Treatment of Intestinal Intussusception in the Peutz-Jeghers Syndrome

Abstract

The hamartomatous polyps of Peutz-Jeghers Syndrome (PJS) can cause repeated episodes of rectal bleeding and intestinal subocclusion. Laparoscopic treatment of intussusception is rarely reported and must be considered for this clinical condition. We described a 35-year-old male with PJS who presented with rectal bleeding and abdominal pain. One duodenal polyp and two others in the jejunum, which caused intussusception, were visualized on preoperative investigation. Polyps were identified by laparoscopy and removed extracorporeally through enterotomies. All lesions were hamartomas. The patient was discharged on the third postoperative day and has been asymptomatic for more than 2 years. Laparoscopy allows an adequate access to explore and treat small bowel polyps and avoid the classic laparotomy.

Adult Intussusception: Diagnosis and Management Strategies. 10 Years Experience from North India

“…Recently, minimally invasive techniques have been used for the treatment of small or large bowel obstructions, specifically the diagnosis and treatment of adult intussusception. There are several case reports about laparoscopic small bowel resection for intussusception [22,23] . The choice of using a minimally invasive or open approach depends on the clinical condition of the patient, the location and extent of intussusception, the possibility of underlying disease, and the availability of surgeons with sufficient laparoscopic expertise [24,25] .…”

Recurrent small intestine intussusception in a patient with Peutz-Jeghers syndrome

“…Intussusception should be reduced and followed by polypectomy (1,2). Because of the recurrence rate small bowel resection should be avoided unless absolutely necessary (2,4) in order to avoid short bowel syndrome and malabsorption (5). Also during laparotomy, the rest of the intestine should be examined and the polyps should be removed either by enterotomies or preferably by intraoperative endoscopic polypectomy (2), even those measuring less than 1 cm.…”

“…PJS is associated with a 2-10% increased risk of gastrointestinal cancer (1) and there seems to be a small but real risk of malignant transformation of hamartomas (2,4). Besides this risk, polypectomy is recommended for polyps in the stomach and colon greater than 1 cm as they can become symptomatic (1-3).…”

“…Gastrointestinal hamartomas occur predominantly in the small intestine (78%), especially the jejunum, but also frequently in the colon (42%), stomach (38%) and rectum (28%) (1). These polyps develop during the first decade of life and can become symptomatic leading to intestinal obstruction (43%), abdominal pain (23%), rectal bleeding (14%) and anal extrusion of polyp (7%) (3,4). We present a case of recurrent intestinal obstruction caused by small bowel intussusception treated by reduction, enterotomy and polypectomy and followed by intraoperative enteroscopy and endoscopic polypectomy.…”

Intussusception in the adult: an unsuspected case of Peutz–Jeghers syndrome with review of the literature

“…There does not appear to be a role for prophylactic colectomy. Furthermore, a laparoscopic technique has been described to reduce an intussusception and remove three polyps [50].…”