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Case Reports
. 2021 Jun 10;15(2):495-500.
doi: 10.1159/000512423. eCollection 2021 May-Aug.

Minimally Invasive Elective Surgery as a Treatment of Bowel Invagination in a Peutz-Jeghers Syndrome Case

Alberto García Picazo  1 , Beatriz López de la Torre  1 , Alfredo Vivas  1 , Francisco J García  1 , Eduardo Ferrero  1
Affiliations
Case Reports

Minimally Invasive Elective Surgery as a Treatment of Bowel Invagination in a Peutz-Jeghers Syndrome Case

Alberto García Picazo et al. Case Rep Gastroenterol. .

Abstract

We present a case of a 24-year-old woman with Peutz-Jeghers syndrome, recurrent colic abdominal pain, and lower gastrointestinal bleed for the last 5 years. Colonoscopy showed hamartomas without any dysplasia. In the enteral magnetic resonance imaging, a distal jejunum and ileum invagination, secondary to hamartomas was detected. The patient was referred to the Surgery Department and despite few symptoms, elective surgery was proposed. By laparoscopic surgery approach, the entire bowel was carefully revised, 3 intussusceptions and bowel volvulus were found, 2 in jejunum and 1 in ileum, causing incomplete obstruction and intestinal dilatation, with a diameter of 6 cm. These intussusception areas were marked with a silk filament, after achieving devolvulation and disinvagination. A 5-cm laparotomy was done, to externalize the entire bowel, to explore it manually, to verify the absence of other lesions, and locate silk points. By longitudinal enterotomies on the antimesenteric intestinal border where silk filaments were located, the polyps were removed through their stalk, and the enterotomies were transversely closed. Postoperative evolution was favorable, starting oral tolerance on the fourth day and being discharged from the hospital on the seventh day. Eight months later, the patient was asymptomatic with a better quality of life.

Keywords: Abdominal pain; Case report; Peutz-Jeghers syndrome; Small bowel obstruction.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Lower gastrointestinal endoscopy. Enormous polyps surrounding the entire colon surface (a, b), colonic lateral polyp (c), virtual chromoendoscopy (d) showing some areas with irregular glandular pattern.
Fig. 2
Fig. 2
a Small bowel appearance. b, c Jejunal invagination areas. d Attempt to correct the intestinal obstruction.
Fig. 3
Fig. 3
a, b Intussusception areas of the small bowel marked with silk (Arrow). c Enterotomy was performed with the electric scalpel, surrounding the lesion. d, e Intestinal polyps in the intestinal lumen. f Enterotomies were transversely closed, with Endo-GIA staplers and absorbable 3/0 suture. Endo-GIA, endovascular gastrointestinal anastomosis.
See this image and copyright information in PMC

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