High cumulative risk of intussusception in patients with Peutz-Jeghers syndrome: time to update surveillance guidelines?

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.

Advances in the prevention, diagnosis and treatment of Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disease caused by inactivating germline mutations of the LKB1/STK11 gene and characterized by mucocutaneous pigmentation, multiple gastrointestinal hamartomatous polyps and family history. Life-threatening complications include intestinal obstruction and an increased risk for developing gastrointestinal malignancies and extraintestinal cancers. Surgery and endoscopic therapy are still main ways to manage gastrointestinal polyposis in PJS patients, and double-balloon enteroscopy has important clinical significance in the diagnosis and treatment of this disease. With the development of translational medicine, molecular targeted therapy (e.g., selective COX-2 inhibitors) brings a new approach to preventive treatment of gastrointestinal polyposis in PJS patients. Traditional Chinese medicine provides an alternative choice. In this paper, we review the recent advances in the prevention, diagnosis and treatment of PJS.

Voluminous intussusception involving the whole midgut in a teenager: a unique differentiation from abdominal cocoon

INTRODUCTION

Intussusception is one of the most frequent complications of Peutz-Jeghers syndrome which has been well described before.

CASE REPORT

Herein, a voluminous intussusception with almost the whole midgut involved in a 13-year-old girl is reported, the radiological presentation was so similar with that of abdominal cocoon that she was initially misdiagnosed accordingly. After the laparotomy confirmation, a careful review was taken on the patient's CT images, a few clues for differentiation were found but proved obscure and an overriding premise for identification is just to take the diagnosis of intussusception into consideration.

CONCLUSION

Based mainly on our experience, clinicians should be aware of voluminous intussusception as a unique differentiation of abdominal cocoon and consider it in each case of voluminous abdominal mass.