A case of intussusception with peutz jeghers syndrome.pptx
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
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
11.
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
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
