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Kuruvila A, Philip P, Thomas A, Benjamin G. A Case Report of a Young Adult With Peutz-Jeghers Syndrome Presenting With Acute Small Bowel Obstruction: A Common Complication of an Uncommon Disease. Cureus 2024; 16:e65931. [PMID: 39221343 PMCID: PMC11365710 DOI: 10.7759/cureus.65931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. Radiological imaging, contrast studies, and scopy-directed biopsies confirm the diagnosis and help in surveillance. Hamartomatous mucosal polyps, which are characterized by a central core of branching smooth muscle connected to a mucosa unique to the site of origin, are pathognomonic for PJS. We present the case of a young male with a history of pain in the abdomen and vomiting. The patient had mucocutaneous pigmentations on the buccal mucosa. CT scan revealed jejuno-jejunal intussusception with multiple small and large bowel polyps causing acute intestinal obstruction. Intraoperatively, jejunal polyps were found to be the cause of jejuno-jejunal intussusception. Histopathology revealed hamartomatous polyps of PJS. Our interest in this case is due to the uncommon case of intussusception in an adult where radiological imaging played an important role in diagnosis.
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Affiliation(s)
- Ashish Kuruvila
- Department of Radiology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, IND
| | - Prince Philip
- Department of Radiology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, IND
| | - Abin Thomas
- Department of Radiology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, IND
| | - Geena Benjamin
- Department of Radiology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, IND
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Wu X, Liang D, He Y. Peutz Jeghers syndrome accompanied with cervical gastric adenocarcinoma and extensive metastasis: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2023; 16:386-392. [PMID: 38188351 PMCID: PMC10767481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024]
Abstract
Female pathological tumors are easily misdiagnosed and missed in clinical practice. Especially in patients with Peutz-Jeghers syndrome (PJS) who often have a variety of rare types of gynecological tumors. We reported a patient with a case of PJS with a lower abdominal mass as the clinical manifestation. Physical and auxiliary examinations showed a large pelvic and abdominal mass. According to the patient's PJS history, gastric adenocarcinoma (GAC) was diagnosed after timely cervical biopsy. The patient underwent abdominal and pelvic mass resection and extensive hysterectomy. The tumor extensively disseminated to the bilateral ovaries, endometrium, fallopian tubes and pelvis. The cyclin-dependent kinase inhibitor 2A gene mutation was demonstrated in cervical GAC samples using next-generation sequencing. We summarized the literature on PJS accompanied by GAC with metastases to bilateral ovaries and analyzed the clinical characteristics of female patients with PJS combined with multiple gynecological tumors. Being aware of the PJS history of the patient is helpful for the standardized diagnosis and treatment of PJS-related gynecological tumors.
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Affiliation(s)
- Xia Wu
- Department of Pathology, West China Second Hospital of Sichuan UniversityChengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of EducationChengdu, Sichuan, P. R. China
| | - Dongni Liang
- Department of Pathology, West China Second Hospital of Sichuan UniversityChengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of EducationChengdu, Sichuan, P. R. China
| | - Ying He
- Department of Pathology, West China Second Hospital of Sichuan UniversityChengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of EducationChengdu, Sichuan, P. R. China
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Fujima T, Saito D, Shibuta H, Ogihara R, Morikubo H, Ozaki R, Tokunaga S, Minowa S, Mitsui T, Miura M, Hayashida M, Watanabe Y, Miyoshi J, Matsuura M, Shibahara J, Ukiyama E, Hisamatsu T. Endoscopic Treatment of Colo-Colonic Intussusception in a Patient with Peutz-Jeghers Syndrome. Case Rep Gastroenterol 2023; 17:339-345. [PMID: 38020466 PMCID: PMC10656115 DOI: 10.1159/000534201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
A 19-year-old man with a history of Peutz-Jeghers syndrome (PJS) and two previous partial small bowel resections because of intussusception presented with lower abdominal pain. Computed tomography (CT) showed concentric multilayer and cord-like structures in the transverse colon. Colo-colonic intussusception was suspected and he was hospitalized. After two therapeutic enemas were unsuccessful, a colonoscopy was performed. The intussusception was reduced and a 40-mm transverse colon polyp with a thick stalk was resected. After the procedure, his abdominal pain was relieved and he was discharged on the sixth hospital day. This case and several previous reports suggest that PJS polyps with tumor diameter exceeding 30 mm and location in the transverse or sigmoid colon can cause intussusception. Endoscopic treatment should be considered for these lesions.
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Affiliation(s)
- Takeshi Fujima
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Daisuke Saito
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hidenori Shibuta
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryota Ogihara
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiromu Morikubo
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryo Ozaki
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Sotaro Tokunaga
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Minowa
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tatsuya Mitsui
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Miki Miura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mari Hayashida
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshiko Watanabe
- Department of Pediatric Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Etsuji Ukiyama
- Department of Pediatric Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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Rahma C, Najoua BK, Mohamed Z, Manel M, Rim D, Mahdi BD, Tahya SB, Riadh M. Peutz-Jeghers syndrome revealed by recurrent small bowel intussusceptions in children: A case report. Clin Case Rep 2022; 10:e6354. [PMID: 36177085 PMCID: PMC9475123 DOI: 10.1002/ccr3.6354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Peutz-Jeghers syndrome is a rare but potentially life-threating syndrome. We report here the case of a young girl who presented recurrent small bowel intussusceptions. Laparotomy exploration showed many jejunal polyps leading to jejunojejunal intussusceptions. These were removed via mini enterotomies and pathological examination concluded to Peutz-Jeghers polyps.
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Affiliation(s)
- Chtourou Rahma
- Department of Pediatric Surgery, Hedi Chaker HospitalUniversity of SfaxSfaxTunisia
| | - Ben Kraiem Najoua
- Department of Pediatric Surgery, Hedi Chaker HospitalUniversity of SfaxSfaxTunisia
| | - Zouari Mohamed
- Department of Pediatric Surgery, Hedi Chaker HospitalUniversity of SfaxSfaxTunisia
| | - Mellouli Manel
- Department of Pathology and Research Laboratory LR18SP10, Habib Bourguiba University Hospital, Faculty of Medicine of SfaxUniversity of SfaxSfaxTunisia
| | - Dghaies Rim
- Department of Pediatric Surgery, Hedi Chaker HospitalUniversity of SfaxSfaxTunisia
| | - Ben Dhaou Mahdi
- Department of Pediatric Surgery, Hedi Chaker HospitalUniversity of SfaxSfaxTunisia
| | - Sellami Boudawara Tahya
- Department of Pathology and Research Laboratory LR18SP10, Habib Bourguiba University Hospital, Faculty of Medicine of SfaxUniversity of SfaxSfaxTunisia
| | - Mhiri Riadh
- Department of Pediatric Surgery, Hedi Chaker HospitalUniversity of SfaxSfaxTunisia
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Aytin YE, Türkyılmaz Z. A rare cause of mechanical intestinal obstruction due to small bowel intussusception: 'A solitary Peutz-Jeghers type hamartomatous polyp'. ULUS TRAVMA ACIL CER 2022; 28:879-883. [PMID: 35652870 PMCID: PMC10443007 DOI: 10.14744/tjtes.2021.34560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022]
Abstract
Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disorder which is characterized by hyperpigmentation in mucocutaneous membranes and hamartomatous polyps in the gastrointestinal tract (GIT). Common complications reported in patients with PSJ are bleeding and mechanical intestinal obstruction due to the hamartomatous polyps. There is also an increased risk of gastrointestinal and extra-intestinal malignancies in patients with PJS. A 28-year-old female patient was admitted to the emergency service with complaints of abdominal pain and vomiting. In addition to distention and tenderness on abdominal examination, revealed hyperpigmented lesions on her lips. An abdominal examination did not reveal any scar from the previous abdominal operation. The patient with suspected mechanical intestinal obstruction at pre-diagnosis demonstrated intussusception in the distal jejunal loops on abdominal tomography. In the diagnostic laparoscopy observed intussusception in jejunal loops. After a minimal suprapubic incision, small intestine loops were checked through alexis with bidigital palpation and no other intraluminal mass were detected. Laparoscopy-assisted jejunojejunal re-section and anastomosis was performed for the intussusception segment, where the polyb is located. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. By the nature of the disease, there may be multiple polyps simultaneously in the GIT and the associated risk of recurrent intussusception attacks in patients with PJS. To prevent short bowel syndrome and intra-abdominal adhesions due to repeated, laparo-tomies treatment with combined endoscopy and laparoscopic/laparoscopy-assisted surgery should be preferred in patients with PJS.
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Affiliation(s)
- Yusuf Emre Aytin
- Department of General Surgery, Edirne Sultan 1. Murat State Hospital, Edirne-Turkey
| | - Zeliha Türkyılmaz
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne-Turkey
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Bellamlih H, El Farouki A, Oulahyane R, Moatassim Billah N, Nassar I. Unusual case of small bowel intussusception in adult revealing a Peutz-Jeghers syndrome. BJR|CASE REPORTS 2022; 8:20210082. [PMID: 36177262 PMCID: PMC9499423 DOI: 10.1259/bjrcr.20210082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/13/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
Abstract
Peutz-Jeghers syndrome is a rare genetic disorder characterized by hyperpigmented
mucocutaneous macules, hamartomatous polyps of the small intestine, and family
history. These hamartomatous polyps can cause intermittent abdominal pain,
chronic anemia, or even intussusception. Imaging has an important role in the
diagnosis of this syndrome but also in the identification of complications and
periodic surveillance. Here, we present a demonstrative case of a Peutz-Jeghers
syndrome associated with intussusception in a 16-year-old patient.
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Affiliation(s)
- Habib Bellamlih
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Ayman El Farouki
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Rachid Oulahyane
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Nabil Moatassim Billah
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Ittimade Nassar
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
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Chiarelli M, Zago M, Tagliabue F, Burati M, Riva C, Vanzati A, Dainese E, Gabrielli F, Guttadauro A, De Simone M, Cioffi U. Small Bowel Intussusception Due to Rare Cardiac Intimal Sarcoma Metastasis: A Case Report. Front Surg 2021; 8:743858. [PMID: 34671641 PMCID: PMC8521089 DOI: 10.3389/fsurg.2021.743858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation. Intussusception is an unusual event in adults, accounting for <5% of bowel obstructions. In most cases it is caused by a malignancy and requires surgical resection. Case Presentation: We describe a rare case of a 50-year-old man suffering of bowel obstruction due to intussusception sustained by a small bowel metastasis of a primary cardiac intimal sarcoma. One year and a half before the onset of abdominal symptoms, a grade II intimal sarcoma was removed from his left atrium and consequently he followed a chemotherapy protocol. Four months later a CT scan revealed local recurrence. Eighteen months after heart surgery he referred to the ER with abdominal pain. CT scan showed an ileal intussusception and the patient was scheduled for surgery. A tract of 10 cm ileus was removed containing an intramural polypoid solid mass. Histological analyses revealed a grade II intimal sarcoma consistent with his first diagnosis. Conclusion: Primary heart tumors are late found and often partially resected, therefore metastatic pathways are to be expected. Adult small bowel intussusception is a rare event and caused by a malignancy in one third of cases. Therefore, our recommendation is to always resect the tract involved in order to perform a proper diagnosis.
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Affiliation(s)
- Marco Chiarelli
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Cristina Riva
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Alice Vanzati
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Emanuele Dainese
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Francesco Gabrielli
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano, Italy
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Ben Hammouda S, Njima M, Ben Abdeljelil N, Bellalah A, Njim L, Zakhama A. An unusual presentation revealing Peutz-Jeghers syndrome in adult. Ann Med Surg (Lond) 2020; 58:87-90. [PMID: 32953105 PMCID: PMC7486423 DOI: 10.1016/j.amsu.2020.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction Peutz-Jeghers syndrome (PJS) is a rare hereditary disease characterized by hyperpigmentation on the lips and oral cavity and gastrointestinal hamartomatous polyps. The most common complications in PJS patients are bleeding, bowel obstruction and intussusception. Presentation of case We hereby report a case of a 33-year-old female, without a family history of the disease, who presented to the emergency room with acute abdominal pain, bloating and not passing gas. On abdominal examination, upper abdominal and periumbilical tenderness was found. Computed tomography (CT) of the abdomen demonstrated suspected ascending colon intussusception. The patient underwent a mid-line laparotomy that showed an ileocolic intussusception. Reduction of this intussusception was successfully done with resection of the affected segment that showed presence of two pedunculated polyps. The specimen was sent thereafter to our department for histopathological evaluation, which confirmed the diagnosis of hamartomatous Peutz-Jeghers polyps with no malignancy. Afterwards, the patient was carefully reexamined and the physical examination revealed multiple pigmented spots on the face and lips. Thus, the diagnosis of Peutz-Jeghers syndrome was made. Discussion PJS is a rare autosomal dominant disorder that often remain undiagnosed for many years. Acute complications such as intestinal obstruction secondary to intussusception is one of infrequent revealing symptoms. Conclusion Early identification, in patients with PJS and family members, as well as close cancer surveillance can improve certainly prognosis in these individuals.
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Affiliation(s)
- Seifeddine Ben Hammouda
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Manel Njima
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Nouha Ben Abdeljelil
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Ahlem Bellalah
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Leila Njim
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Abdelfattah Zakhama
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
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Kutikuppala LV, Sathvika M, Pratti S, Atmakuri S. Peutz Jeghers syndrome presenting as intestinal obstruction with ileocolic intussusception: a rare presentation. MAMC JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/mamcjms.mamcjms_29_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Hamilton AE, Singh A, Austin KK, Shin J, Hong JS. A Rare Pathological Couplet of Colocolic Intussusception Plus Cecal Bascule in a Young Adult: A Case Report. Cureus 2018; 10:e3430. [PMID: 30546977 PMCID: PMC6289586 DOI: 10.7759/cureus.3430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This report is of a rare case involving a 27-year-old female who presented to the hospital with the pathological couplet of colocolic intussusception and cecal bascule causing bowel obstruction. Up to the time of presentation to the hospital, this patient had not undergone a full investigation for a known iron deficiency, anemia. Subsequently, during the emergency admission and after having an operative surgical procedure, the patient was found to have both a congenitally malpositioned cecum and a benign colonic polyp-forming condition. The pertinent issues about this unusual case to be highlighted are its ambiguous clinical presentation; uncommon gender and age group for either condition; the simultaneous occurrence of dual anatomical anomalies; and the uncommon benign etiology of causes of bowel obstruction in adults.
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Affiliation(s)
| | - Angad Singh
- Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, AUS
| | - Kirk K Austin
- Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, AUS
| | - JooShik Shin
- Pathology, Royal Prince Alfred Hospital, Sydney, AUS
| | - Jonathan S Hong
- Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, AUS
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Demir Yenigürbüz F, Deveci U, Tuncez E. Peutz-Jeghers Syndrome: A Very Rare Cause of Iron Deficiency Anemia. Turk J Haematol 2018; 36:50-51. [PMID: 30040067 PMCID: PMC6373507 DOI: 10.4274/tjh.galenos.2018.2018.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Fatma Demir Yenigürbüz
- Şanlıurfa Training and Research Hospital, Clinic of Pediatric Hematology, Şanlıurfa, Turkey
| | - Uğur Deveci
- Şanlıurfa Training and Research Hospital, Clinic of Pediatric Gastroenterology, Şanlıurfa, Turkey
| | - Ebru Tuncez
- Şanlıurfa Training and Research Hospital, Clinic of Medical Genetics, Şanlıurfa, Turkey
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