An unusual presentation revealing Peutz-Jeghers syndrome in adult

Abstract

Introduction: Peutz-Jeghers syndrome (PJS) is a rare hereditary disease characterized by hyperpigmentation on the lips and oral cavity and gastrointestinal hamartomatous polyps. The most common complications in PJS patients are bleeding, bowel obstruction and intussusception.

Presentation of case: We hereby report a case of a 33-year-old female, without a family history of the disease, who presented to the emergency room with acute abdominal pain, bloating and not passing gas. On abdominal examination, upper abdominal and periumbilical tenderness was found. Computed tomography (CT) of the abdomen demonstrated suspected ascending colon intussusception. The patient underwent a mid-line laparotomy that showed an ileocolic intussusception. Reduction of this intussusception was successfully done with resection of the affected segment that showed presence of two pedunculated polyps. The specimen was sent thereafter to our department for histopathological evaluation, which confirmed the diagnosis of hamartomatous Peutz-Jeghers polyps with no malignancy. Afterwards, the patient was carefully reexamined and the physical examination revealed multiple pigmented spots on the face and lips. Thus, the diagnosis of Peutz-Jeghers syndrome was made.

Discussion: PJS is a rare autosomal dominant disorder that often remain undiagnosed for many years. Acute complications such as intestinal obstruction secondary to intussusception is one of infrequent revealing symptoms.

Conclusion: Early identification, in patients with PJS and family members, as well as close cancer surveillance can improve certainly prognosis in these individuals.

Keywords: Hamartomatous polyp; Intestinal obstruction; Intussusception; Peutz-Jeghers syndrome.

Fig. 1

(A): CT of abdomen showed ileocolic intussusception (asterisks), which extended over 18cm with “target sign” (B).

Fig. 2

Gross examination of the ileocolic resection specimen. At the opening, it showed a segment of small intestine invaginating into the adjoining intestinal lumen consistent with an intussusception that had caused large bowel obstruction. This segment had two pedunculated polyps measuring 3 × 1.5cm and 3.5 × 2cm (asterisks).

Fig. 3

Histological findings, hematoxylin and eosin (x100). A, B: Peutz-Jeghers polyp characterized by villous architecture and arborizing smooth muscle cores. The mucosa covering the polyp was hyperplastic and often ulcerated, with no sign of malignancy.