A Pediatric Case of Intussusception Due to a Peutz-Jeghers Polyp

Abstract

An 11-year-old boy with no notable family history was brought to our department for an urgent examination because of chief complaints of intense, intermittent upper abdominal pain and bilious vomiting. There was no pigmentation in the lips or the distal portion of the extremities. Enteric intussusception was the diagnosis based on the results of detailed tests, and the patient underwent emergency surgery on the same day of the visit. Enteric intussusception was noted 240 cm proximally from the ileocecum, and this was repositioned using the Hutchinson technique. Because a mass was detected in the advanced part, approximately 4 cm of the small intestine was resected and end-to-end anastomosis was performed. A pedunculated, lobulated polyp was observed in the resected small intestine and was pathologically diagnosed as a Peutz-Jeghers (PJ) polyp. Genetic analysis was performed to eliminate the possibility of PJ syndrome (PJS). As the results indicated no STK11/LKB1 genetic mutation, PJS was ruled out. Detailed tests performed later did not reveal any obvious polyps. Relatively few pediatric cases of intussusception caused by a PJ polyp have been reported in Japan. Although differentiation from PJS is important in follow-up examinations after PJ polyp resection, some patients have no family history of PJS and exhibit few physical findings. Accordingly, sufficiently detailed tests, including genetic analysis, is required to rule out the possibility of PJS.