A case of Peutz-Jeghers syndrome with intussusception of small bowel caused by polyps treated with three surgical operations in the past twenty years

Abstract

A 35-year-old male was admitted to our hospital with anemia. He had been observed almost regularly for the past 20 years under the diagnosis of Peutz-Jeghers Syndrome, and had been operated three times due to the intussusceptions. At the latest operation, after restoration of intussusception of small bowel, the tumor (6cm in diameter) palpated inside the intussusception was resected. Forty-three polyps of small bowel were resected endoscopically, in combination with an apparatus called'Preparation-Set’to prevent the bacterial contamination. The specimens from past operations and other polypectomies show no sign of malignancy.
The Peutz-Jeghers polyps frequently cause the intussusceptions and other abdominal symptoms, but also the malignant alteration of those polyps is known. Careful follow-up intestinal examinations has been performed, though the examination of small bowel still rely on the X-ray radiographies since small bowel enteroscopy is still limited in clinical situations. And also the polypectomy of those polyps often requires laparotomies, which are likely emergency cases due to intussusceptions. However, after several surgical operations, observation of those polyps itself becomes more difficult due to the adhesions. Therefore non-invasive methods are recommended from the first step of diagnosis of this syndrome to reduce hardships in the future.