Peutz-Jeghers syndrome complicated with small bowel intussusception managed by laparoscopy-assisted transoral single-balloon enteroscopy

Abstract

Fig. 1. A 16-year-old girl presented with intermittent upper abdominal ain and passage of tarry stool for one month. She had ever received hipple procedure twelve years ago for large pancreatic cystic neolasm. On physical examination, she appeared pigmented macules ver the lips and pale conjunctiva, and the laboratory examination evealed microcytic anaemia. Her abdominal contrasted computed omography showed small intestine-to-small intestine intussuseption leaded by a large polyp (Fig. 1A, arrow). The antegrade ingle-balloon enteroscopy (enteroscope, SIF-Q260; splinting tube, T-SB1; balloon controller, MAJ-1725, Olympus Medical Systems orp., Tokyo, Japan) using push-and-pull method revealed one 3m large polyp (Fig. 1B) with intussusception stalk (Fig. 1C, arrow) oted at mid-jejunum, however, endoloop-assisted polypectomy ailed, probably due to large size of the polyp and intestinal dhesion caused by previous Whipple operation. Minimally invaive procedure with laparoscopic assisted transoral single balloon nteroscopy was performed for adhesiolysis and reduction of ntussusception (Fig. 2A, arrow: intussusception point), and simulaneous transoral enteroscopic polypectomy (VIO 200D, ERBE USA, nc., EndoCut® Q effect setting 2, 60 W) was done successfully. otal sixteen polyps were removed. The pathology revealed hamaromatous polyp (Fig. 2B), and Peutz-Jeghers (PJ) syndrome was iagnosed. Currently, no female or gastrointestinal tract maligancy was found under yearly follow up at gynaecologist outpatient epartment and surveillance enteroscopy twice annually. Because of intestinal adhesion secondary to repeated surgery f PJ syndrome patients, natural orifice luminal endoscopic proedures are sometimes very difficult and short bowel syndrome fter multiple resection of intestines is sometimes inevitable [1].