Peutz-Jeghers Syndrome Associated with Intestinal Carcinoma The Merit of Endoscopic Polypectomy Under Laparotomy

Makoto Kume, Kei Yonezawa, Hisaya Azuma, Shigeru Mori, Tetsuji Yoneyama, Manabu Futamura, Hidekazu Yamamoto, Takashi Shiroko, Ryoji Okamoto, Naoki Yokoo

Department of Surgery, Takayama Red Cross Hospital

A case of Peutz-Jeghers syndrome associated with carcinoma of the small intestine is reported. The patient was a 25-year-old male, in whom Peutz-Jeghers syndrome was diagnosed at the age of 7 based on pigmented spots on the lips, hands and soles, and rectal polyps. At the age of 24, an episode of intestinal obstruction led to surgical resection of jejunal intussusception. During the operation, a massive group of jejunal and ileal polyps was found by palpation. At the age of 25, endoscopic polypectomy of the small intestine was performed under laparotomy. An enteroscope was introduced alternately through the openings in the small intestine, one 140 cm from the terminal ileum and the other 50 cm from Treitz ligament. In this way, 107 polyps (5 mm or over) were resected. On microscopic examination, although 105 polyps were described as having the typical Peutz-Jeghers pattern (hamartomatous), carcinomatous glands were found in parts of 2 polyps (26 mm and 7 mm in diameter). This suggests that polyps seen in Peutz-Jeghers syndrome should be considered potentialy malignant, and resected regardless of their size. Endoscopic polypectomy under laparotomy serves this purpose.

Key words
peutz-Jeghers syndrome, carcinoma in the intestinal polyp, endoscopic polypectomy under laparotomy

Reprint requests
Makoto Kume Department of Surgery, Takayama Red Cross Hospital
3-11 Tenman-cho, Takayama, 506 JAPAN

Accepted
May 11, 1994

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