Gonzalez Angel Mario Morales, Clapp Benjamin
Texas Tech University Health Sciences Center at El Paso, Department of Surgery, El Paso, Texas 79912, USA.
JSLS. 2008 Jul-Sep;12(3):332-4.
Peutz-Jeghers is a rare autosomal dominant disorder characterized by hamartomatous polyps and discoloration of mucosal membranes. The polyps can occur anywhere in the gastrointestinal tract and can grow large enough to cause bowel obstructions.
A 16-year-old male presented to the emergency department with signs and symptoms of an acute bowel obstruction. He had 2 days of abdominal pain, obstipation, and vomiting. He had a previous history of a colonoscopy with polypectomy at age 4, and hyperpigmentation of his mucous membranes.
Computed tomographic (CT) scan revealed an intussusception of the small intestine. An exploratory laparoscopy found an intussusception of the mid jejunum. A laparoscopic-assisted small bowel resection was performed. Pathology showed a 5-cm polyp that acted as a lead point for the intussusception. Colonoscopy and upper endoscopy revealed 5 more polyps in the stomach and colon that were removed.
Small bowel obstructions can be managed successfully with minimally invasive approaches. The treatment of obstruction in these patients is to remove the offending hamartomatous polyp(s). The rest of the intestine needs to be examined and those polyps found should be removed. This can be done intraoperatively with laparoscopic-assisted enteroscopy and colonoscopy.
黑斑息肉综合征是一种罕见的常染色体显性疾病，其特征为错构瘤性息肉和黏膜色素沉着。息肉可出现在胃肠道的任何部位，且可长得足够大而导致肠梗阻。
一名16岁男性因急性肠梗阻的症状和体征就诊于急诊科。他有2天的腹痛、便秘和呕吐症状。他既往有4岁时接受结肠镜检查及息肉切除术的病史，且有黏膜色素沉着。
计算机断层扫描（CT）显示小肠套叠。腹腔镜探查发现空肠中段套叠。实施了腹腔镜辅助小肠切除术。病理显示一个5厘米的息肉，它是套叠的起始点。结肠镜检查和上消化道内镜检查发现胃和结肠还有5个息肉并予以切除。
小肠梗阻可通过微创方法成功处理。这些患者梗阻的治疗方法是切除引起问题的错构瘤性息肉。需要对肠道其余部分进行检查，发现的息肉应予以切除。这可在术中通过腹腔镜辅助小肠镜检查和结肠镜检查完成。
