A Case Report and Literature Review of a Rare Jejunal Solitary Peutz–Jeghers-Type Polyp Resected Endoscopically in an Elderly Patient Presenting with Subacute Gastrointestinal Bleeding

IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Case Reports in Gastrointestinal Medicine Pub Date : 2023-12-18 DOI:10.1155/2023/2391602
Talal Alenezi, Victoria Marcus, T. Bessissow
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Abstract

Solitary Peutz–Jeghers-type polyp (SPJP) is a rare hamartomatous lesion. It is considered a different entity from Peutz–Jeghers syndrome despite similar histopathological findings. It can be found in the GI tract but rarely in the jejunum. Jejunal SPJP is susceptible to necrosis, ulceration, and intussusception, resulting in GI bleeding or small bowel obstruction. We describe a case of subacute gastrointestinal bleeding secondary to jejunal SPJP to share our approach to this challenging case using therapeutic endoscopy. An 81-year-old male patient with a history of atrial fibrillation on warfarin with stable therapeutic INR levels presented with a 1-week history of melena, generalized fatigue, and shortness of breath on exertion and was found to have profound iron deficiency anemia. Esophageal gastroduodenoscopy and colonoscopy failed to identify the source of bleeding; however, single-balloon enteroscopy detected a 4 cm polyp with a stalk in the proximal jejunum. Endoscopic polypectomy was performed, and the whole polyp was removed. Histopathological examination was consistent with Peutz–Jeghers polyp. The genetic analysis was negative for STK11 mutation. Follow-up magnetic resonance enterography and video capsule endoscopy did not reveal any other polypoid lesion in the GI tract. The patient’s symptoms resolved gradually, and his hemoglobin level returned back to normal levels within 6 months. To our knowledge, this is the first case of endoscopic polypectomy during balloon-assisted enteroscopy for jejunal SPJP.
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一名出现亚急性胃肠道出血的老年患者在内镜下切除了一个罕见的空肠孤立性 Peutz-Jeghers 型息肉的病例报告和文献综述
孤立性 Peutz-Jeghers 型息肉(SPJP)是一种罕见的hamartomatous病变。尽管组织病理结果相似,但它被认为是与 Peutz-Jeghers 综合征不同的一种疾病。它可出现在消化道,但很少出现在空肠。空肠 SPJP 易发生坏死、溃疡和肠套叠,导致消化道出血或小肠梗阻。我们描述了一例继发于空肠 SPJP 的亚急性消化道出血病例,并分享了我们使用治疗性内镜来处理这一具有挑战性病例的方法。一位 81 岁的男性患者有心房颤动病史,曾服用华法林,INR 水平稳定在治疗水平,一周前出现血便、全身乏力和用力时气短,被发现患有深度缺铁性贫血。食管胃十二指肠镜检查和结肠镜检查均未发现出血源;但单球囊肠镜检查在空肠近端发现了一个 4 厘米的带蒂息肉。患者接受了内镜下息肉切除术,整个息肉被切除。组织病理学检查结果与 Peutz-Jeghers 息肉一致。基因分析显示 STK11 突变为阴性。随访的磁共振肠道造影和视频胶囊内镜检查未发现消化道有其他息肉病变。患者的症状逐渐缓解,血红蛋白水平在 6 个月内恢复到正常水平。据我们所知,这是首例在球囊辅助肠镜下进行内镜息肉切除术治疗空肠 SPJP 的病例。
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来源期刊
Case Reports in Gastrointestinal Medicine
Case Reports in Gastrointestinal Medicine GASTROENTEROLOGY & HEPATOLOGY-
自引率
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发文量
33
审稿时长
14 weeks
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