Peutz-Jeghers syndrome (PJS) is a genetic disorder characterized by the development of gastrointestinal hamartomatous polyps and mucocutaneous melanin pigmentation. Patients with PJS are at risk of complications such as intussusception. Intussusception is a condition where one segment of the intestine invaginates into another, causing intestinal obstruction. We report a PJS patient who was diagnosed with double intussusception in a single setting.

A 16-year-old teenage male PJS patient presented with a history of colicky abdominal pain, vomiting, blood in stools, loss of appetite, and weight loss. On abdominal examination, a vague mass was palpable over the right upper quadrant. Contrast-enhanced computed tomography (CT) of the abdomen was performed and an intussusception involving the jejunum and rectosigmoid junction was observed. The patient subsequently underwent a laparotomy and intussusception involving the jejunum and another over the ileum was noted intra-operatively. Bowel resection and an endoscopic polypectomy were performed, followed by a primary anastomosis. The patient was discharged well and reviewed again one month later, and was noted to be well.

PJS patients have a high risk of intussusception and can be diagnosed accurately by endoscopic surveillance or radiologically with abdominal CT or magnetic resonance imaging. The mainstay of treatment is surgical intervention followed by endoscopic surveillance with periodic polypectomy.

• Peutz-Jeghers syndrome
• Intussusception
• Case report

Intussusception is quite uncommon in adults. We report a rare case of a 76-year-old man with small bowel intussusception induced by two indwelling bowel tubes, the first a jejunal feeding tube and the second an ileus tube. After complete reduction of the first intussusception caused by the jejunal feeding tube and adhesion, re-intussusception occurred due to the postoperative adhesion and ileus tube inserted into the bowel after the previous operation for intussusception. Finally, the part of the jejunum with re-intussusception and adhesion, including the place where the previous reduced intussusception had occurred, was resected. This case is a reminder that when there is no mucosal lesion other than an indwelling bowel tube or a hard adhesion/inflammation around intussusception, the patient should be operated on without delay for resection of the intussusception to prevent re-intussusception, even if the resected bowel is predicted to be long.

• Intussusception
• Recurrence
• Feeding tube
• Ileus tube
• Small intestine

• P50 CA095817 NCI NIH HHS

Peutz-Jeghers syndrome (PJS) is a rare familial disorder characterised by mucocutaneous pigmentation, gastrointestinal and extragastrointestinal hamartomatous polyps and an increased risk of malignancy. Peutz-Jeghers polyps in the bowel may result in intussusception. This complication usually manifests with abdominal pain and signs of intestinal obstruction.

We report the case of a 24-year-old Caucasian male who presented with melaena. Pigmentation of the buccal mucosa was noted but he was pain-free and examination of the abdomen was unremarkable. Upper gastrointestinal endoscopy revealed multiple polyps. An urgent abdominal computed tomography (CT) scan revealed multiple small bowel intussusceptions. Laparotomy was undertaken on our patient, reducing the intussusceptions and removing the polyps by enterotomies. Bowel resection was not needed.

Melaena in PJS needs to be urgently investigated through a CT scan even in the absence of abdominal pain and when clinical examination of the abdomen shows normal findings. Although rare, the underlying cause could be intussusception, which if missed could result in grave consequences.

• Cecal Diseases/complications
• Cecal Diseases/diagnosis
• Cecal Diseases/surgery
• Cecum/pathology
• Cecum/surgery
• Colonoscopy
• Humans
• Intestinal Polyposis/complications
• Intestinal Polyposis/diagnosis
• Intestinal Polyposis/surgery
• Intussusception/complications
• Intussusception/diagnosis
• Intussusception/surgery
• Male
• Middle Aged

AIM: To assess the usefulness of double-balloon enteroscopy (DBE) for the detection and treatment of small-bowel polyps in patients with Peutz-Jeghers syndrome.

METHODS: We performed a prospective evaluation of patients with clinically proved Peutz-Jeghers syndrome who were enrolled in DBE surveillance and treatment program. The size, number of the endoscopically resected small-bowel polyps, and the complications associated with the examination or treatment were documented.

RESULTS: Thirty-four DBE procedures were carried out in 18 patients (oral approach in 18, anal approach in 16). The mean duration of the procedure was 95 (range 65-180) min. Small-bowel polyps were detected in all patients (100%). A total of 126 polyps (diameter 5-10 mm, 16 polyps; 11-30 mm: 70 polyps; >30 mm: 40 polyps; the largest diameter: 50 mm) were resected endoscopically. One carcinomatous change of polyp was noted. A total of three complications occurred (1 perforation occurred 3 days after endoscopic resection, 2 abdominal pains, non-bleeding with a fall in Hb), and no other severe complications occurred.

CONCLUSION: DBE is a safe and reliable procedure for the treatment of mid-small bowel polyps in patients with Peutz-Jeghers syndrome. It revolutionizes the therapeutic options for polyps in the region of the mid-small bowel and limits the indications for primary surgical management.

• Peutz-Jeghers syndrome
• Polyp of small intestine
• Double-balloon enteroscopy
• Therapeutic endoscopy