Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome
A 13-year-old girl presented with sudden-onset colicky abdominal pain and biliary vomiting. She was diagnosed with Peutz-Jeghers syndrome 2 months previously based on mucocutaneous pigmentation and hamartomatous polyposis. On diagnosis of Peutz-Jeghers syndrome, in addition to colonoscopy and esopha...
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Elsevier
2020-08-01
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Series: | Journal of Pediatric Surgery Case Reports |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576620301536 |
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author | Yoshiko Nakayama Sawako Kato Shingo Kurasawa Reina Nakamura Tomoaki Suga Masahiro Kurozumi |
author_facet | Yoshiko Nakayama Sawako Kato Shingo Kurasawa Reina Nakamura Tomoaki Suga Masahiro Kurozumi |
author_sort | Yoshiko Nakayama |
collection | DOAJ |
description | A 13-year-old girl presented with sudden-onset colicky abdominal pain and biliary vomiting. She was diagnosed with Peutz-Jeghers syndrome 2 months previously based on mucocutaneous pigmentation and hamartomatous polyposis. On diagnosis of Peutz-Jeghers syndrome, in addition to colonoscopy and esophagogastroduodenoscopy, antegrade and retrograde double-balloon enteroscopies were performed, and >10 hamartomas were resected. She was scheduled for additional elective double-balloon enteroscopy for total small-bowel observation. On visiting the emergency unit, enhanced abdominal computed tomography showed jejuno-jejunal intussusception with a polyp. There were no ischemic signs in the invaginated bowel. Urgent antegrade double-balloon enteroscopy performed 5 hours after onset of acute abdominal symptoms revealed a large polyp with intussusception stalk in the jejunum, and simultaneous reduction of intussusception and endoscopic mucosal resection of the polyp were performed successfully. There were no endoscopy-related complications, and emergent laparotomy was avoided. The patient has been asymptomatic, and total gastrointestinal screening is scheduled every 2 years. This is the first case in which emergent laparotomy was avoided by urgent double-balloon enteroscopy in an adolescent with symptomatic jejuno-jejunal intussusception. Non-surgical management of small-bowel polyps in pediatric patients with Peutz-Jeghers syndrome is beneficial as laparotomy can cause bowel adhesion and increases risk of incomplete balloon-assisted enteroscopy. |
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issn | 2213-5766 |
language | English |
last_indexed | 2024-12-21T12:11:22Z |
publishDate | 2020-08-01 |
publisher | Elsevier |
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series | Journal of Pediatric Surgery Case Reports |
spelling | doaj.art-c40973c087284a58a158854bc2be86c42022-12-21T19:04:34ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662020-08-0159101519Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndromeYoshiko Nakayama0Sawako Kato1Shingo Kurasawa2Reina Nakamura3Tomoaki Suga4Masahiro Kurozumi5Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan; Corresponding author. Department of Pediatrics, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Pediatrics, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Gastroenterology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Gastroenterology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Radiology, Shinshu University School of Medicine, Matsumoto, JapanA 13-year-old girl presented with sudden-onset colicky abdominal pain and biliary vomiting. She was diagnosed with Peutz-Jeghers syndrome 2 months previously based on mucocutaneous pigmentation and hamartomatous polyposis. On diagnosis of Peutz-Jeghers syndrome, in addition to colonoscopy and esophagogastroduodenoscopy, antegrade and retrograde double-balloon enteroscopies were performed, and >10 hamartomas were resected. She was scheduled for additional elective double-balloon enteroscopy for total small-bowel observation. On visiting the emergency unit, enhanced abdominal computed tomography showed jejuno-jejunal intussusception with a polyp. There were no ischemic signs in the invaginated bowel. Urgent antegrade double-balloon enteroscopy performed 5 hours after onset of acute abdominal symptoms revealed a large polyp with intussusception stalk in the jejunum, and simultaneous reduction of intussusception and endoscopic mucosal resection of the polyp were performed successfully. There were no endoscopy-related complications, and emergent laparotomy was avoided. The patient has been asymptomatic, and total gastrointestinal screening is scheduled every 2 years. This is the first case in which emergent laparotomy was avoided by urgent double-balloon enteroscopy in an adolescent with symptomatic jejuno-jejunal intussusception. Non-surgical management of small-bowel polyps in pediatric patients with Peutz-Jeghers syndrome is beneficial as laparotomy can cause bowel adhesion and increases risk of incomplete balloon-assisted enteroscopy.http://www.sciencedirect.com/science/article/pii/S2213576620301536Double-balloon enteroscopyIntussusceptionPeutz-Jeghers syndrome |
spellingShingle | Yoshiko Nakayama Sawako Kato Shingo Kurasawa Reina Nakamura Tomoaki Suga Masahiro Kurozumi Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome Journal of Pediatric Surgery Case Reports Double-balloon enteroscopy Intussusception Peutz-Jeghers syndrome |
title | Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome |
title_full | Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome |
title_fullStr | Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome |
title_full_unstemmed | Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome |
title_short | Urgent double-balloon enteroscopy for reduction of jejuno-jejunal intussusception and polypectomy in Peutz-Jeghers syndrome |
title_sort | urgent double balloon enteroscopy for reduction of jejuno jejunal intussusception and polypectomy in peutz jeghers syndrome |
topic | Double-balloon enteroscopy Intussusception Peutz-Jeghers syndrome |
url | http://www.sciencedirect.com/science/article/pii/S2213576620301536 |
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