Observation:
An 8-year-old girl presented to the emergency department of our hospital
with recurrent abdominal pain and vomiting, which were suddenly
worsened. She had no family history of gastrointestinal pathologies.
Upon presentation, the patient had good vital signs. Physical
examination showed dark pigmentations of the buccal mucosa (Figure 1)
and epigastric tenderness on palpation. Abdominal ultrasound (US)
revealed extensive small bowel intussusception. Then, the patient
underwent emergent laparoscopic exploration and successful
intussusception reduction. One month later, she had once again the same
symptoms with recurrence of the small bowel intussusception at US. An
abdominal CT scan associated to upper gastrointestinal series was
performed showing polypoid lesions inside the intestinal lumen (Figure
2). Laparotomy exploration was achieved to our patient through an upper
midline incision. We found and reduced the small bowel intussusception.
Then, the whole intestine was checked, permitting the identification at
the jejunum wall of multiple intraluminal polypoid formations with a
biggest of 3 cm of diameter (Figure 3), which were totally removed
through limited enterotomies. Bowel resection was not needed.
Pathological examination of the specimens confirmed hamartomas with
smooth muscle arborisation, compatible with Peutz Jeghers polyps,
without malignancy signs (Figure 4). The postoperative course was
uneventful. The patient was then referred to gastrologist for further
exploration. Esophago-gastroduodenoscopy revealed two sessile polyps in
the stomach; 5 and 12 mm of diameter, which were endoscopically removed.
Colonoscopy disclosed only one sessile polyp of 6 mm (Figure 5).