The use of ultrasound to demonstrate small bowel polyps in a patient with Peutz-Jeghers syndrome

Unusual presentation of intussusception of the small bowel with peutz jeghers syndrome: report of a case

The Peutz Jeghers syndrome (PJS) is an autosomal dominant disorder which is characterised by hamartomatous polyposes of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. We are reporting a case of a 15-year-old male with Peutz Jeghers syndrome, who presented to us with features of chronic intestinal obstruction and anaemia. Initially, patient was managed conservatively, but later on, an elective exploratory laparotomy was done for definitive management of intussusception. Laparotomy revealed a jejuno-jejunal intussusception with spontaneous recanalisation of gut which contained a long segment of gangrenous small bowel in the lumen. Resection and anastomosis of the jejunal segment was done. To the best of our knowledge, this might be the first case report on spontaneous recanalisation of small intestine.

Clinical presentations and surgical approach of acute intussusception caused by Peutz-Jeghers syndrome in adults

INTRODUCTION

Peutz-Jeghers syndrome is a rare autosomal dominantly inherited disease characterized by mucocutaneous pigmentations and gastrointestinal polyps. The polyps are located predominantly in the small intestine and usually cause intussusceptions. Adult intussusception caused by Peutz-Jeghers syndrome occurs very rarely. The purpose of this study was to analyze the clinical characteristics, preoperative diagnosis, and surgical management of Peutz-Jeghers syndrome associated with acute intussusception in adult patients.

DISCUSSION

Consecutive patients with the postoperative diagnosis of acute intussusception caused by Peutz-Jeghers syndrome from 1995 to 2010 were reviewed retrospectively for this study. Data concerning clinical considerations, morphological examinations, and surgical procedure were analyzed. Different clinical manifestations were presented in patients with intussusception due to Peutz-Jeghers syndrome. Computed tomography associated or not with ultrasonography may be the most accurate examination for acute intussusceptions caused by Peutz-Jeghers syndrome. Surgical intervention is the first choice regimen in acute intussusceptions caused by Peutz-Jeghers syndrome. Prophylaxis and polypectomy of the entire small bowel is a worthy way in Peutz-Jeghers syndrome patients to reduce the frequency of laparotomies.

Radiological work-up in Peutz-Jeghers syndrome

BACKGROUND

The development of modern imaging studies such as high-resolution US and various MR imaging sequences have enabled their application to the examination of the gastrointestinal tract. OBJECTIVE. To compare radiological contrast studies, US and MRI in patients with Peutz-Jeghers syndrome (PJS).

MATERIALS AND METHODS

Ten members of two families were evaluated. The patients were divided into three groups according to the presence of perioral pigmentations and current clinical symptomatology. Patients were examined using US, MRI and radiological contrast studies.

RESULTS

In the disease-free family members ( n=3), no pathological findings were found. In asymptomatic ( n=4) and symptomatic patients ( n=3), polyps were demonstrated using contrast studies in all cases. MRI demonstrated all the polyps. Ultrasound revealed the polyps in three out of six patients. In addition to the polyps, intussusceptions were shown. There was no evidence of malignant transformation on any of the studies.

CONCLUSIONS

Although PJS is a childhood or teenage disease, patients should be closely monitored during adulthood because of the development of gastrointestinal and extragastrointestinal malignancies. Contrast studies remain the gold standard. However, radiological follow-up could be undertaken by US or MRI, which would not impose a radiation burden during life-time follow-up.