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Polyp Clearance via Operative and Endoscopic Polypectomy in Patients With Peutz-Jeghers Syndrome After Multiple Small Bowel Resections.

Lee do H, Shin HD, Cho WH, Shin KH, Lee S, Shin JE, Namgung H, Gwon JE - Intest Res (2014)

Bottom Line: We report the case of a 40-year-old male patient who was diagnosed 20 years ago and had previously undergone 3 intestinal resection surgeries.This time, with the use of combined operative and endoscopic polypectomy, more than 100 polyps were removed.This technique is useful for providing a "clean" small intestine that allows the patient a long interval between laparotomies and reduces the complications associated with multiple laparotomies and resections.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
Peutz-Jeghers syndrome is an autosomal dominant inherited disease that manifests as a combination of mucocutaneous pigmentation and gastrointestinal hamartomatous polyps that usually cause intussusception and intestinal hemorrhage. We report the case of a 40-year-old male patient who was diagnosed 20 years ago and had previously undergone 3 intestinal resection surgeries. This time, with the use of combined operative and endoscopic polypectomy, more than 100 polyps were removed. This technique is useful for providing a "clean" small intestine that allows the patient a long interval between laparotomies and reduces the complications associated with multiple laparotomies and resections.

No MeSH data available.


Related in: MedlinePlus

Microscopic findings. (A) Typical hamartomatous polyps characterized by tree-like branching bands of smooth muscle with normal surrounding hyperplastic epithelium (H&E, ×10). (B) Dysplastic change of Fig. 4D (H&E, ×40). (C) Proliferation of neoplastic epithelial cells with nuclear hyperchromasia and pseudostratification (H&E, ×100). (D) Marked increases in mitosis and nuclear pseudostratification in the basal half of the epithelial cells (H&E, ×200).
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Figure 6: Microscopic findings. (A) Typical hamartomatous polyps characterized by tree-like branching bands of smooth muscle with normal surrounding hyperplastic epithelium (H&E, ×10). (B) Dysplastic change of Fig. 4D (H&E, ×40). (C) Proliferation of neoplastic epithelial cells with nuclear hyperchromasia and pseudostratification (H&E, ×100). (D) Marked increases in mitosis and nuclear pseudostratification in the basal half of the epithelial cells (H&E, ×200).

Mentions: The patient did not want frequent endoscopic procedures. We considered a method to remove all of the polyps at one time. After one month, the patient underwent elective laparotomy to remove the remaining jejunal and ileal polyps. Enterotomy was performed at 1 site on the jejunum and 3 sites on the ileum. The incision was made longitudinally along the lumen, with an incision length similar to the circumference of the small bowel. The small bowel was evaginated, and the length of the evaginated bowel was about 50 cm near the incision site in the jejunum and 10-20 cm in the ileum. Evagination of a longer length was possible in the jejunum, probably because of prominent bowel dilatation because of numerous polyps and frequent intussusceptions over a long period. Next, we performed an operative polypectomy without small bowel resection. Nearly the entire small bowel was observed. We attempted to remove all polyps larger than 1 cm. A total of 76 polyps were surgically removed (Fig. 5). The procedure time was 4 hours 25 minutes. After this procedure, an intraoperative endoscopic examination was performed to check for remnant small bowel polyps, and there were no polyps of significant size (>1 cm). Histologic examination of the polyps removed from the colon and small bowel showed typical hamartomatous polyps characterized by tree-like branching bands of smooth muscle with normal surrounding hyperplastic epithelium (Fig. 6A). One colonic polyp showed high-grade dysplasia (Fig. 6B-D).


Polyp Clearance via Operative and Endoscopic Polypectomy in Patients With Peutz-Jeghers Syndrome After Multiple Small Bowel Resections.

Lee do H, Shin HD, Cho WH, Shin KH, Lee S, Shin JE, Namgung H, Gwon JE - Intest Res (2014)

Microscopic findings. (A) Typical hamartomatous polyps characterized by tree-like branching bands of smooth muscle with normal surrounding hyperplastic epithelium (H&E, ×10). (B) Dysplastic change of Fig. 4D (H&E, ×40). (C) Proliferation of neoplastic epithelial cells with nuclear hyperchromasia and pseudostratification (H&E, ×100). (D) Marked increases in mitosis and nuclear pseudostratification in the basal half of the epithelial cells (H&E, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214960&req=5

Figure 6: Microscopic findings. (A) Typical hamartomatous polyps characterized by tree-like branching bands of smooth muscle with normal surrounding hyperplastic epithelium (H&E, ×10). (B) Dysplastic change of Fig. 4D (H&E, ×40). (C) Proliferation of neoplastic epithelial cells with nuclear hyperchromasia and pseudostratification (H&E, ×100). (D) Marked increases in mitosis and nuclear pseudostratification in the basal half of the epithelial cells (H&E, ×200).
Mentions: The patient did not want frequent endoscopic procedures. We considered a method to remove all of the polyps at one time. After one month, the patient underwent elective laparotomy to remove the remaining jejunal and ileal polyps. Enterotomy was performed at 1 site on the jejunum and 3 sites on the ileum. The incision was made longitudinally along the lumen, with an incision length similar to the circumference of the small bowel. The small bowel was evaginated, and the length of the evaginated bowel was about 50 cm near the incision site in the jejunum and 10-20 cm in the ileum. Evagination of a longer length was possible in the jejunum, probably because of prominent bowel dilatation because of numerous polyps and frequent intussusceptions over a long period. Next, we performed an operative polypectomy without small bowel resection. Nearly the entire small bowel was observed. We attempted to remove all polyps larger than 1 cm. A total of 76 polyps were surgically removed (Fig. 5). The procedure time was 4 hours 25 minutes. After this procedure, an intraoperative endoscopic examination was performed to check for remnant small bowel polyps, and there were no polyps of significant size (>1 cm). Histologic examination of the polyps removed from the colon and small bowel showed typical hamartomatous polyps characterized by tree-like branching bands of smooth muscle with normal surrounding hyperplastic epithelium (Fig. 6A). One colonic polyp showed high-grade dysplasia (Fig. 6B-D).

Bottom Line: We report the case of a 40-year-old male patient who was diagnosed 20 years ago and had previously undergone 3 intestinal resection surgeries.This time, with the use of combined operative and endoscopic polypectomy, more than 100 polyps were removed.This technique is useful for providing a "clean" small intestine that allows the patient a long interval between laparotomies and reduces the complications associated with multiple laparotomies and resections.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
Peutz-Jeghers syndrome is an autosomal dominant inherited disease that manifests as a combination of mucocutaneous pigmentation and gastrointestinal hamartomatous polyps that usually cause intussusception and intestinal hemorrhage. We report the case of a 40-year-old male patient who was diagnosed 20 years ago and had previously undergone 3 intestinal resection surgeries. This time, with the use of combined operative and endoscopic polypectomy, more than 100 polyps were removed. This technique is useful for providing a "clean" small intestine that allows the patient a long interval between laparotomies and reduces the complications associated with multiple laparotomies and resections.

No MeSH data available.


Related in: MedlinePlus