腸重積を繰返し,4回目の開腹術を施行したPeutz-Jeghers症候群の1例

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  • A CASE OF PEUTZ-JEGHERS SYNDROME UNDERGONE THE 4TH LAPAROTMY BECAUSE OF REPEATED INTUSSUSCEPTIONS

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Intussusception is an important complication of Peutz-Jeghers syndrome. We describe here a case of PeutzJeghers syndrome in which repeatedly developed intussusceptions led to the 4th laparotomy, together with a review of the literature. <BR>A 39-year-old man had received a total of 3 times of laparotomy since his 15 years old when he was diagnosed as Peutz-Jeghers syndrome. This time the patient was refferred to our hospital for ileus. From strict examination intussusception was suspected, emergency operation being carried out. During the operation, an intussusception headed with a polyp of the small intestine as well as a longitudinally 360°-rotated volvulus were found. The patient was diagnosed as strangulated ileus, and underwent enterectomy by 90cm. An otherwise finding was a huge polyp at the horizontal crus of duodenal intestine, for which endoscopic polypectomy was carried out postoperatively, leading to an uneventful course. Peutz-Jeghers syndrome often accompanies by repeated intussusceptions like this case. Especially in a multioperative case, its preoperative diagnosis may be difficult to be made, where routine follow-up and appropriate and prompt decision-making for operation are entirely needed.

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