Cunningham J D, Vine A J, Karch L, Aisenberg J
Department of Surgery, The Mount Sinai Medical Center, New York, New York, USA.
Surg Laparosc Endosc. 1998 Feb;8(1):17-20.
A 15-year-old girl with known Peutz-Jeghers syndrome and with nausea and vomiting of all ingested food was transferred from an outside institution. Physical examination revealed a palpable upper abdominal mobile mass. Upper gastrointestinal series revealed a stacked coin appearance consistent with small bowel intussusception. An abdominal computed tomographic scan showed a left upper quadrant sausage-shaped mass with invagination of bowel into bowel suggestive of small bowel intussusception. The patient was taken to the operating room for a combined upper endoscopy and laparoscopy. Laparoscopy confirmed the radiologic findings and a jejuno-jejunal intussusception was identified and reduced laparoscopically. The endoscope could not be passed to the level of the polyp, thus, this loop of small bowel was resected laparoscopically. The final pathologic diagnosis was multiple hamartomas. We conclude that laparoscopy is a safe and effective method of managing intussusception in the Peutz-Jegher syndrome because the pathologic lead point is a benign hamartoma. A combined endoscopic and laparoscopic approach can be used to treat proximal small bowel intussusception and this could possibly eliminate the need for laparotomy and reduce the post-operative complications associated with multiple reoperations in this patient population.
一名15岁已知患有黑斑息肉综合征的女孩，出现摄入的食物全部呕吐伴恶心症状，从外地医疗机构转来。体格检查发现上腹部可触及活动肿块。上消化道造影显示呈堆叠硬币样外观，符合小肠套叠表现。腹部计算机断层扫描显示左上腹有一腊肠样肿块，肠管套入肠管，提示小肠套叠。患者被送往手术室进行联合上消化道内镜检查和腹腔镜检查。腹腔镜检查证实了影像学检查结果，发现并通过腹腔镜复位了空肠-空肠套叠。内镜无法通过至息肉部位，因此，这一段小肠通过腹腔镜切除。最终病理诊断为多发性错构瘤。我们得出结论，腹腔镜检查是治疗黑斑息肉综合征患者套叠的一种安全有效的方法，因为病理引导点是良性错构瘤。联合内镜和腹腔镜方法可用于治疗近端小肠套叠，这可能消除剖腹手术的必要性，并减少该患者群体因多次再次手术相关的术后并发症。
