Ulus Travma Acil Cerrahi Derg. 2022; 28(6): 879-883 | DOI: 10.14744/tjtes.2021.34560

Ýnce baðýrsak intusepsiyonuna baðlý nadir bir mekanik baðýrsak obtrüksiyon nedeni: “Peutz-Jeghers tipi soliter hamartomatöz polip’’

Yusuf Emre Aytin¹, Zeliha Türkyýlmaz^2
1Edirne Sultan 1. Murat Devlet Hastanesi, Genel Cerrahi Kliniði, Edirne
²Trakya Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Edirne

Peutz-Jeghers Sendromu (PJS), mukokutanöz membranlarda hiperpigmentasyon ve gastrointestinal sistemde hamartomatöz polipler ile kendini gösteren otozomal dominant geçiþli, nadir bir hastalýktýr. Hamartomatöz poliplere baðlý kanama ve mekanik intestinal obstrüksiyon bu hastalar için bildirilen baþlýca komplikasyonlardýr. Ayrýca PJS’li hastalarda artmýþ gastrointestinal ve gastrointestinal dýþý malignite riski mevcuttur. Yirmi sekiz ya-þýnda kadýn hasta karýn aðrýsý ve kusma þikayetleri ile acil servise baþvurdu. Karýn muayenesinde distansion ve hassasiyet olan hastanýn dudaklarýnda hiperpigmente lezyonlar görüldü. Karýn muayenesinde geçirilmiþ karýn operasyonuna ait skar gözlenmedi. Ön tanýda mekanik intestinal obstrüksiyon düþünülen hastanýn, karýn tomografisinde distal jejunal anslarda intusepsiyon varlýðý tespit edldi. Tanýsal laparoskopide jejunal anslarda intusepsiyon gözlendi. Suprapubik yapýlan minimal insizyondan sonra, ince baðýrsak anslarý aleksis içerisinden bidigital palpasyon ile kontrol edildi ve baþka bir lümen içi kitle tespit edilmedi. Polibin bulunduðu intususepsiyon segmenti içine alan laparoskopik yardýmlý jejunojejunal rezeksiyon ve anastomoz uygulandý. PJS’li hastalarda, hastalýðýn doðasý gereði gastrointestinal sistemde ayný anda birden fazla polip olabilir ve bununla iliþkili olarak tekrarlayan intusepsiyon ataklarý riski vardýr. Kýsa baðýrsak sendromu ve tekrarlayan laparotomilere baðlý karýn içi yapýþýklýklarý önlemek için PJS’li hastalarda kombine endoskopi ve laparoskopik/laparoskopik yardýmlý cerrahi tedavi tercih edilmelidir.

Anahtar Kelimeler: Hamartomatöz polip, intusepsiyon; laparoskopik cerrahi; Peutz-Jeghers sendromu.

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A rare cause of mechanical intestinal obstruction due to small bowel intussusception: “A solitary Peutz-Jeghers type hamartomatous polyp”

Yusuf Emre Aytin¹, Zeliha Türkyýlmaz^2
1Department of General Surgery, Edirne Sultan 1. Murat State Hospital, Edirne-Turkey
²Department of General Surgery, Trakya University Faculty of Medicine, Edirne-Turkey

Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disorder which is characterized by hyperpigmentation in mucocutaneous membranes and hamartomatous polyps in the gastrointestinal tract (GIT). Common complications reported in patients with PSJ are bleeding and mechanical intestinal obstruction due to the hamartomatous polyps. There is also an increased risk of gastrointestinal and extra-intestinal malignancies in patients with PJS. A 28-year-old female patient was admitted to the emergency service with complaints of abdominal pain and vomiting. In addition to distention and tenderness on abdominal examination, revealed hyperpigmented lesions on her lips. An abdominal examination did not reveal any scar from the previous abdominal operation. The patient with suspected mechanical intestinal obstruction at pre-diagnosis demonstrated intussusception in the distal jejunal loops on abdominal tomography. In the diagnostic laparoscopy observed intussusception in jejunal loops. After a minimal suprapubic incision, small intestine loops were checked through alexis with bidigital palpation and no other intraluminal mass were detected. Laparoscopy-assisted jejunojejunal re-section and anastomosis was performed for the intussusception segment, where the polyb is located. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. By the nature of the disease, there may be multiple polyps simultaneously in the GIT and the associated risk of recurrent intussusception attacks in patients with PJS. To prevent short bowel syndrome and intra-abdominal adhesions due to repeated, laparo-tomies treatment with combined endoscopy and laparoscopic/laparoscopy-assisted surgery should be preferred in patients with PJS.

Keywords: Hamartomatous polyp, intussusception; laparoscopic surgery; Peutz-Jeghers syndrome.

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