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Case of Intussusception with Peutz Jeghers Syndrome
- 1. A case of intussusception with peutz jeghers syndrome By DR NAILA JABBAR REGISTRAR Surgical Unit-1
- 2. CASE HISTORY • Patient Aashir, 15 years old male • Presenting complaints • Presented to surgical emergency with trauma to Right leg and fracture of right tibia for which department of orthopedics applied backslab initally • Next day while still in surgical emergency, patient developed severe abdominal pain which worsened with time and he developed rectal bleed and vomiting over next 2 days • patient was admitted to ward on conservative lines and further workup was started
- 3. MEDICAL HISTORY • Patient is a diagnosed case of Peutz-Jeghers Syndrome • Diagnosed at the age of 7 years
- 4. FAMILY HISTORY • Father is also a diagnosed case of Peutz-Jeghers Syndrome • Underwent laparotomy (record not available) 10 years ago • 1 younger brother and 1 sister are also diagnosed as having Peutz- Jeghers Syndrome • Maternal grandmother died of CA lung 7 years ago
- 5. EXAMINATION • A 15 years old male well oriented and cooperative • On Examination • Vitals: patient was tachycardiac, tachypneic and hypotensive • There was hyper-pigmentation on lips and palms • Abdominal examination: • Abdomen distended, tense and tender • Bowel sounds were sluggish
- 6. WORKUP USG ABDOMEN • Few edematous gut loops are seen in lower abdomen below the umbilicus • Maximum wall thickness is 9mm • No peristaltic movement seen • Minimal interloop fluid is also noted
- 7. WORKUP CT SCAN ABDOMEN • Focal mild mural thickening in gastric fundus • Few enhancing small non-obstructing intraluminal polyps are seen in jujenum • The proximal jujenal segments are dilated and fluid filled with walls edema • Intussusception is noted at Jujeno / Jujeno-ileal Level • Although no obvious mass seen at lead point but few lymph nodes are seen at intussusception • Rest of the CT scan unremarkable
- 9. LABORATOTY INVESTIGATIONS • CBC • TLC: 8.1 • PLT: 312 • Hb: 9.2 • All other labs in normal range
- 10. MANAGEMENT • After investigations and re-evaluation, plan was made to proceed with Exploratory Laparotomy • OPERATION • Exploratory laparotomy + Resection and Anastomosis of Jujeum (1.5 feet of jujenum resected) • IOF: • Distended gut around 2 feet Jujenum distal to DJ • 1.5 feet of gangrenous gut around 2 feet from DJ • Mesenteric lymphadenopathy • Meckel’s Diverticulum
- 12. POST-OPERATIVE PERIOD • Post operative recovery was satisfactory. • Patient was discharged after 5 days • Patient has been on regular follow-up • BIOPSY REPORT • Transmural Dense Inflammation
- 13. POST-OPERATIVE PERIOD • Post Operative Colonoscopy • Sigmoid Colon • A large polyp seen at rectosigmoid junction about 30cm from anal verge
- 21. INTUSSUSEPTION
- 22. INTRODUCTION • A serious condition in which part of the intestine slides into an adjacent part of the intestine. • This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected
- 23. PATHOPYHSIOLOGY
- 26. DIAGNOSIS • Abdominal X-rays • Abdominal USG • Barium meal (outline the concave meniscus sign/clowe sign) • CT scan
- 27. MANAGMENT • Conservative • NG • Resuscitation • Non-operative: • Hydrostatic reduction with barium • Water soluble isotonic contrast reduction • Pnematic reduction • Operative: • exploratory laporotomy with/without resection anastomiosis • Laparoscopic
- 28. THANK YOU