BACKGROUND Peutz-Jeghers syndrome (PJS) is a genetic disorder characterized by the development of gastrointestinal hamartomatous polyps and mucocutaneous melanin pigmentation. Patients with PJS are at risk of complications such as intussusception. Intussusception is a condition where one segment of the intestine invaginates into another, causing intestinal obstruction. We report a PJS patient who was diagnosed with double intussusception in a single setting. CASE SUMMARY A 16-year-old teenage male PJS patient presented with a history of colicky abdominal pain, vomiting, blood in stools, loss of appetite, and weight loss. On abdominal examination, a vague mass was palpable over the right upper quadrant. Contrast-enhanced computed tomography (CT) of the abdomen was performed and an intussusception involving the jejunum and rectosigmoid junction was observed. The patient subsequently underwent a laparotomy and intussusception involving the jejunum and another over the ileum was noted intra-operatively. Bowel resection and an endoscopic polypectomy were performed, followed by a primary anastomosis. The patient was discharged well and reviewed again one month later, and was noted to be well. CONCLUSION PJS patients have a high risk of intussusception and can be diagnosed accurately by endoscopic surveillance or radiologically with abdominal CT or magnetic resonance imaging. The mainstay of treatment is surgical intervention followed by endoscopic surveillance with periodic polypectomy.

Methods: An eleven-year prospective database included 1482 emergency admissions (53%) was maintained. Most biliary emergencies are referred as a matter of protocol. The work load is recognized in job planning, with agreement to 40% elective surgery. Theatre utilization is maximized through using on call and CEPOD lists. Results: Other consultants or hospitals referred 87%. 72% were first presentations. Admission-to-referral was 3.9 days, 68% undergoing surgery within 5 days. 67% had suspected choledocholithiasis, 35% undergoing ductal explorations. 47% of cholecystectomies were done on open elective lists, 28.4% while on call and 24.6% in CEPOD theatre. The mean operation time was 84 minutes and mean hospital stay 6.9 days. We recorded 4.5% complications, 6 re-laparoscopies, 3 deaths and one conversion. Conclusion: Emergency biliary surgery during the index admission for all patients presenting with cholelithiasis with or without CBD stones is possible with low rates of complications if a dedicated team exists, timely referral occurs and access to theatre is made flexible by the provision of open lists. There are clear benefits to clinical and to other outcome parameters such as waiting times, number of episodes, hospital stay and presentation to resolution intervals.