Small-bowel perforation in a patient with Roux-en-Y anatomy for Peutz-Jeghers polyps after spiral enteroscopic investigation

Summary: Peutz-Jeghers syndrome is a rare genetic disorder characterized by gastrointestinal polyps and pigmentation. Laparoscopic-assisted disinvagination and polypectomy is a useful, minimally invasive treatment for PJS patients with multiple intussusceptions caused by small intestinal polyps.

Summary: We report a case of a young girl with Peutz-Jeghers syndrome who had recurrent small bowel intussusceptions. Laparotomy exploration revealed multiple jejunal polyps leading to jejunojejunal intussusceptions, which were removed via mini enterotomies. Pathological examination confirmed Peutz-Jeghers polyps.

Summary: According to the recommendations from ESGE, small-bowel capsule endoscopy is the recommended first-line examination for suspected small-bowel bleeding due to its excellent safety profile and patient tolerability. In cases of overt suspected small-bowel bleeding, small-bowel capsule endoscopy should be conducted as soon as possible, ideally within 48 hours after the bleeding episode to maximize diagnostic and therapeutic benefits. Routine second-look endoscopy before small-bowel capsule endoscopy is not recommended for patients with suspected small-bowel bleeding or iron-deficiency anemia. Conservative management is recommended for patients with suspected small-bowel bleeding and negative small-bowel capsule endoscopy. If lesions are identified, device-assisted enteroscopy can be used for confirmation and possibly treatment. Small-bowel capsule endoscopy is recommended as the first-line examination for patients with iron-deficiency anemia when small bowel evaluation is indicated. Small-bowel capsule endoscopy is also recommended in patients with suspected Crohn's disease and negative ileocolonoscopy findings, as well as in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging if it is likely to influence patient management. A patency capsule should be used before small-bowel capsule endoscopy in patients with established Crohn's disease to decrease the capsule retention rate. Device-assisted enteroscopy can be used as an alternative to surgery for retrieving foreign bodies in the small bowel in patients without acute intestinal obstruction. Additionally, DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) is recommended as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy, except for Billroth II patients.

Summary: Patients with Peutz-Jeghers Syndrome often require surgery for intestinal obstructions, with traditional methods being potentially unsuitable. The innovative approach described by the authors, using a short midline laparotomy for intestinal treatment, successfully reduced the risk of small bowel resections for patients.

Summary: This case report presents a rare case of intussusception caused by Peutz-Jeghers syndrome. Through this case, it serves as a reminder for emergency physicians to consider intussusception as a potential diagnosis in patients presenting with abdominal pain and bowel obstruction.

Summary: Gastric bypass and biliopancreatic diversion procedures have evolved from loop configurations to Roux-en-Y configurations and back to loop configurations as one anastomosis gastric bypass and single-anastomosis duodenal switch. Surgeons often do not measure the lengths of the common channel (CC) and biliopancreatic limb (BPL), resulting in variable outcomes related to limb length. This article evaluates the literature on the effects of varying limb lengths on the outcomes of Roux-en-Y gastric bypass.

Summary: Peutz-Jeghers syndrome is a rare inherited disease characterized by pigmentation of the skin and multiple polyps in the gastrointestinal tract. It is associated with cancers in the gastrointestinal tract and other organs.

Summary: The feasibility of using a cap-assisted colonoscope as the primary approach for ERCP in patients undergoing REY reconstruction was evaluated. The intubation success rate using a cap-assisted colonoscope was higher in the SS-JJ group compared to the SE-JJ group. SS-JJ was a predictive factor for successful intubation.

Summary: This article presents cases of marginal ulcers (MUs) in patients who have undergone Roux-en-Y gastric bypass (RYGB) surgery and discusses the different treatment strategies. MUs have a wide range of complex clinical presentations, and managing them requires familiarity with their anatomic variances and operative skill to effect resolution.

Summary: Intussusception with a pathological lead point is rare in children. This case report describes a 3-year-old boy with small bowel intussusception caused by a solitary polyp of the Peutz-Jeghers (P-J) type. Preoperative CT scan clearly showed the pathological lead point. Emergency laparotomy was performed and the necrotic part of the small bowel containing the polyp was resected. Postoperative recovery was uneventful. The case highlights the usefulness of contrast-enhanced CT scan in confirming both intussusception and the pathological lead point, and the importance of distinguishing solitary P-J-type polyps from P-J syndrome during regular follow-up.

Summary: We report a case of a 27-year-old man with Peutz-Jeghers syndrome who presented with intussusception. Histology from surgical specimens revealed Peutz-Jeghers polyps, one of which had low-grade dysplasia. This case highlights the rare possibility of intussusception in adults with PJS.

Summary: We present a case of a 33-year-old male with severe abdominal pain, anorexia, nausea, and vomiting. Computed tomography revealed intussusception and a jejunal mass, which was identified as a hamartomatous polyp with features of Peutz-Jeghers syndrome. Although the patient lacked typical signs of PJS, such as mucocutaneous pigmentation and family history, a definitive diagnosis of solitary PJS-type hamartomatous polyps was made based on histopathological findings.

Summary: Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disorder characterized by hyperpigmentation and hamartomatous polyps in the gastrointestinal tract. Common complications include bleeding, mechanical intestinal obstruction, and increased risk of malignancies.

Summary: This meta-analysis aimed to evaluate the outcomes and safety of endoscopic ultrasound-directed trans-gastric retrograde cholangiopancreatography (EDGE) in patients with Roux-en-Y gastric bypass (RYGB). The results showed that EDGE had high technical and clinical success rates, but a relatively high adverse event rate, with LAMS dislodgement being the most common adverse event. The adverse event rate was significantly lower with 20-mm LAMS compared to 15-mm LAMS, suggesting the preference for the former.