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...

Full description

Bibliographic Details
Main Authors: Yoshiko Nakayama, Sawako Kato, Shingo Kurasawa, Reina Nakamura, Tomoaki Suga, Masahiro Kurozumi
Format: Article
Language:English
Published: Elsevier 2020-08-01
Series:Journal of Pediatric Surgery Case Reports
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2213576620301536
_version_ 1819051905904541696
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.
first_indexed 2024-12-21T12:11:22Z
format Article
id doaj.art-c40973c087284a58a158854bc2be86c4
institution Directory Open Access Journal
issn 2213-5766
language English
last_indexed 2024-12-21T12:11:22Z
publishDate 2020-08-01
publisher Elsevier
record_format Article
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
work_keys_str_mv AT yoshikonakayama urgentdoubleballoonenteroscopyforreductionofjejunojejunalintussusceptionandpolypectomyinpeutzjegherssyndrome
AT sawakokato urgentdoubleballoonenteroscopyforreductionofjejunojejunalintussusceptionandpolypectomyinpeutzjegherssyndrome
AT shingokurasawa urgentdoubleballoonenteroscopyforreductionofjejunojejunalintussusceptionandpolypectomyinpeutzjegherssyndrome
AT reinanakamura urgentdoubleballoonenteroscopyforreductionofjejunojejunalintussusceptionandpolypectomyinpeutzjegherssyndrome
AT tomoakisuga urgentdoubleballoonenteroscopyforreductionofjejunojejunalintussusceptionandpolypectomyinpeutzjegherssyndrome
AT masahirokurozumi urgentdoubleballoonenteroscopyforreductionofjejunojejunalintussusceptionandpolypectomyinpeutzjegherssyndrome