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PEUTZ–JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERY
Author(s) -
Yada Kazuhiro,
Inomata Masafumi,
Adachi Yosuke,
Kitano Seigo,
Kashima Kenji,
Sakai Masahiro,
Sakai Iwami
Publication year - 2003
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1046/j.1443-1661.2003.00205.x
Subject(s) - medicine , hypoproteinemia , heart failure , sigmoid colon , colonoscopy , peutz–jeghers syndrome , anemia , gastrointestinal bleeding , surgery , rectum , protein losing enteropathy , pleural effusion , gastroenterology , enteropathy , colorectal cancer , disease , cancer
We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz–Jeghers (P–J) polyposis successfully treated by laparoscopic surgery. A 49‐year‐old woman was admitted for severe cough and edema of the extremities. Chest X‐ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99m Tc‐diethylene triamine penta‐acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy‐assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P–J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P–J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding.