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Laparoscopic
segmental resection of the jejunum for hamartomatous polyp presented as
intermittent intussusception and diagnosed by wireless capsule endoscopy
O. Avrutis1, O. Sibirsky1, V.
Michalevsky1, E. Tzvang3, S.
Adler2,
H. Jacob2, A. Durst1
Department of Surgery1 and Unit of
Gastroenterology2, Bikur
Cholim Hospital,
Jerusalem
Unit of
Gastroenterology3, Hadassah
University Hospital,
Jerusalem
Background:
Benign tumors of the small bowel are rare and often remain asymptomatic
throughout life. However, these tumors are the leading cause of
intussusception in adults. Small symptomatic lesions in the small intestine
may not show up in radiological studies (up to 70%), and are inaccessible
to conventional endoscopy. Prevalence of hamartomatous polyp of the small
bowel is 1 per 200,000.
Case report: A
healthy 55-year-old women was presented in outpatient clinic with
intermittent colicky abdominal pain and vomiting of six months duration.
Upper endoscopy, colonoscopy and barium upper GI series were normal. An
abdominal CT was performed, demonstrating 2.5cm. lesion with
intussusception in the proximal jejunum without evidence of obstruction.
Wireless capsule endoscopy detected a pedunculated polyp in the same area,
and the rest small intestine seemed to be normal. The patient underwent
totally laparoscopic segmental resection of the jejunum with intracorporeal
anastomosis using Endo-GIA stapler. Resected segment of the bowel was
retrieved inside Endo-Bag through 12-mm port wound. The surgery took 105
minutes. Presented Video depicts unique laparoscopic view of bowel
intussusception and technical details of the procedure. Postoperative
period was uneventful. The patient was discharged on postoperative day 5.
Sections of the resected jejunum reveled hamartomatous (Peutz-Jeghers type)
polyp.
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