T h e majority of cases give a characteristic story of recurrent central abdominal colic which has in many cases been sufficiently severe to require emergency laparotomy. The presence of the distinctive pigmentation and of intestinal colic would appear to be sufficient to justify the diagnosis.
CASE REPORTA. B., a woman aged 27 years, was seen for the first time in the Out-patient Department of the Royal Victoria Infirmary, Newcastle upon Tyne.She gave a history of two recent emergency operations at another hospital for acute abdominal pain. At the first laparotomy on April 27,1951, she was thought to have a perforated peptic ulcer, but was discovered to have an ileo-ilia1 intussusception which was easily reduced. The cause was not discovered.The second operation on March 29, 1952, for a similar attack showed an ileo-ilia1 intussusception with an ileal polyp at its apex. Reduction was carried out, but the patient's condition did not allow removal of the polyp.In view of this story, and the fact that she was having recurrent mild attacks of intestinal colic, she was admitted for assessment and laparotomy.ON EmINATION.-The patient was found to be a healthy young woman of good physique with marked freckling of the face, lips, and dorsal aspects of the interphalangeal joints (Fig. 579). The abdomen showed two recent laparotomy scars but no other abnormality.Barium meal and follow-through using the Sprue technique showed "possibly one or two polyps in the small intestine. Demonstration not very convincing". more polyps were felt in a loop of bowel showing many adhesions suggesting previous intussusception. This was also resected.The patient made a good recovery. PATHOLOGICAL REPoRT.-The pathologist, Dr. Schade, reported :-I. The first specimen showed a length of ileum 27 un., which had been opened longitudinally. On the mucosal aspect were numerous adenomata, the majority less than 0.5 cm., with three larger adenomata 2 cm., in diameter also present (Fig. 580).
2.The second specimen is a portion of jejunum 20 cm.