Extra-ampullary Peutz–Jeghers polyp causing duodenal intussusception leading to biliary obstruction: a case report

Abstract

BackgroundDuodenal Peutz–Jeghers polyp is a rare cause of duodenal or biliary obstruction. However, a sporadic Peutz–Jeghers polyp leading to simultaneous biliary and duodenal obstruction has not been reported.Case presentationWe report a case of a 25-year-old Sri Lankan woman presenting with features of recurrent upper small intestinal obstruction and biliary obstruction. She had clinical as well as biochemical evidence of intermittent biliary obstruction. Evidence of duodenal intussusception was found in a computed tomography enterogram and a duodenal polyp was noted as the lead point. Marked elongation and distortion of her lower common bile duct with intrahepatic duct dilatation was also noted and the ampulla was found to be on the left side of the midline pulled toward the intussusceptum. Open polypectomy and reduction of intussusception were done and she became fully asymptomatic following surgery. Histology of the resected specimen was reported as a typical “Peutz–Jeghers polyp”. As there was not enough evidence to diagnose Peutz–Jeghers syndrome this was considered to be a sporadic Peutz–Jeghers polyp.ConclusionRare benign causes such as a duodenal polyp should be considered and looked for in initial imaging, when the cause for concurrent biliary and intestinal obstruction is uncertain, particularly in young individuals.

Acute duodenal obstruction secondary to intussusception caused by the duodenal diverticulum: a case report

“…However, in the present case, duodenal intussusception occurred due to diverticulum. In extreme cases, duodenal intussusception can lead to biliary obstruction [7,8].…”

High-Tech Diagnostic Methods and Enteroscopic Treatment of Children with Peutz-Jeghers Syndrome

“…The format of the study in this case does not imply a comparison of the results of the experimental and reference groups: to prove the effectiveness of the method, we cannot create a control group even from a small number of children and allow them to develop perforation: the perforation rate with open techniques is approximately 5%. 4,[16][17][18] The optimality and efficiency of the developed algorithm are determined by the presence of unique endoscopic equipment and the anatomical features of the localization of PJ polyps. Enteroscopy provides removal of polyps from the deep parts of the small intestine, it is an additional method for VCE.…”

“…Treatment is most often surgical-highly invasive resection, because, due to polyp structure feature standard polypectomy is associated with a high risk of bowel perforation. [16][17][18] Many patients with PJS during life undergo repeated laparotomies with bowel resection for invaginations and acute intestinal obstruction, gastrointestinal bleeding, extensive intestinal polyposis, and malignant neoplasms; in most patients, open surgery leads to the development of secondary complications: adhesive obstruction and short bowel syndrome. [17][18][19] Hightech intraluminal endoscopy allows for complete diagnosis and minimally invasive removal of hamartomatous polyps, eliminating the need for surgical treatment.…”

“…[22][23][24][25][26] The primary task is to prevent abdominal surgery due to late diagnosis, leading to the development of complications, the most frequent and severe of which is acute intestinal obstruction due to invagination. 16,17,[27][28][29] However, there is little information in the literature about the efficiency and safety of polypectomy in the small intestine during enteroscopy in children with PJS. [30][31][32][33] A breakthrough in the diagnosis and treatment of benign tumors of the small intestine was the introduction into clinical practice of instrumental-assisted methods, in particular balloon enteroscopy (single-balloon, double-balloon).…”

Peutz–Jeghers syndrome with intermittent upper intestinal obstruction

“…The main symptom of this patient is intermittent upper intestinal obstruction caused by mass duodenal polyps, which rarely obstruct the duodenum. [ 13 , 14 ] As there are no definitive guideline for the treatment to duodenal PJS hamartomatous polyp, [ 15 ] each case requires tailor-made management.…”