Successful Endoscopic Reduction of an Ileocolonic Intussusception in an Adult With Peutz-Jeghers Syndrome 2111

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S1202
• Main Authors: Alsamman, Mohd Amer, Ferreira, Jason, Akerman, Paul
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Abdomen; Endoscopy; Gastroenterology; Intestinal obstruction; Polyps; Small intestine
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-02110

Intussusceptions are mostly seen in pediatric population and only 5% in adults, nearly all reported cases are managed with a surgical approach. Endoscopic treatment for PIS-related intussusception has been described in a few pediatrics cases, but not in adults. A 19-year-old male patient with known Peutz-Jeghers syndrome with no previous abdominal surgeries and known history of multiple hamartomatous polyps removed on previous endoscopies presented with abdominal pain, nausea, and vomiting. Laboratory workup revealed a hemoglobin of 10 g/dl with an MCV of 62 f/cl but was otherwise unremarkable including normal LFTs and electrolytes. A contrast enhanced CT scan of abdomen and pelvis revealed a colo-colonic intussusception and multiple thickened enhancing loops of jejunum with a 2.7 cm by 1.7 cm lobulated cecal polyp seen adjacent to the ileocecal valve. After evaluation by surgery and gastroenterology, we decided to pursue endoscopic intervention. He underwent colonoscopy that showed a 35 mm pedunculated polyp in the transverse colon not noted on imaging as well as the aforementioned cecal polyp. Both were endoscopically resected using a hot snare. After that, attention was shifted to a 20 cm segment of intussuscepted ileum in the ascending colon. A 0.035 inch-long wire was passed through the lumen of the intussuscepted ileum and a biliary stone extraction balloon was then passed over the wire and inflated within the intussuscepted intestine to give traction to endoscopically reduce the intestinal segment back to its natural position. Following the endoscopic reduction, the ileocecal valve and ileum were noted to be edematous but no ischemic changes were noted. The patient s symptoms completely resolved and he required no further intervention. Six months following hospital discharge, he underwent both upper and retrograde spiral enteroscopy that showed multiple hamartomatous polyps in the small bowel with selected resection of the larger sized polyps. Over a year has passed and he remained free of complication or recurrence. Surgical management has been the gold standard for intussusception in adults, but in the era of advanced imaging that allows for early diagnosis, endoscopic management should be considered especially when patients present early prior to development of bowel compromise. Future studies should analyze patient outcomes with endoscopy in comparison to a surgical