A CASE OF PEUTZ-JEGHERS SYNDROME TREATED BY INTRAOPERATIVE POLYPECTOMY FOR RECURRENCE OF INTUSSUSCEPTION CAUSED BY POLYPS OF THE SMALL INTESTINE

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A 30-year-old man was seen at the hospital because of abdominal pain and vomiting. He had a history of undergoing laparotomy for intussusception and was diagnosed as having Peutz-Jeghers syndrome (PJS) at the age of 12. Computed tomography (CT) of the abdomen showed two intestinal intussusceptions; one in the jejunum and the other in the ileocecal portion. We diagnosed the case as intussusception caused by an intestinal tumor and performed laparotomy. Only ileocecal intussusception was confirmed and reduced manually, then ileal resection was performed.Five days later, intussusception occurred again, so the second operation was arranged at the postoperative 12th day. On laparotomy, an intussusception was found in the jejunum and reduced manually. We then applied enteroscopy through an enterotomy incision in the jejunum to remove 10 polyps endoscopically for the prevention of intussusception. The patient was discharged from the hospital without recurrence after the second operation. Thereafter he has been free from complaints for 14 months.Patient with PJS often have to undergo multiple laparotomies for repeated intussusception of the small intestine and/or gastrointestinal bleeding. Intraoperative polypectomy for multiple intestinal polyps can be expected to prolong symptom-free interval.
日本臨床外科学会の論文