THE ROLE OF LAPAROSCOPY IN THE MANAGEMENT OF INTUSSUSCEPTION IN THE PEUTZ-JEGHERS-SYNDROME - CASE-REPORT AND REVIEW OF THE LITERATURE

A 15-year-old girl with known Peutz-Jeghers syndrome and with nausea a nd vomiting of all ingested food was transferred from an outside insti tution. Physical examination revealed a palpable upper abdominal mobil e mass, Upper gastrointestinal series revealed a stacked coin appearan ce consistent with small bowel intussusception. An abdominal computed tomographic scan showed a left upper quadrant sausage-shaped mass with invagination of bowel into bowel suggestive of small bowel intussusce ption. The patient was taken to the operating room for a combined uppe r endoscopy and laparoscopy. Laparoscopy confirmed the radiologic find ings and a jejuno-jejunal intussusception was identified and reduced l aparoscopically. The endoscope could not be passed to the level of the polyp, thus, this loop of small bowel was resected laparoscopically. The final pathologic diagnosis was multiple hamartomas. We conclude th at laparoscopy is a safe and effective method of managing intussuscept ion in the Peutz-Jegher syndrome because the pathologic lead point is a benign hamartoma. A combined endoscopic and laparoscopic approach ca n be used to treat proximal small bowel intussusception and this could possibly eliminate the need for laparotomy and reduce the post-operat ive complications associated with multiple reoperations in this patien t population.