Recurrent Intestinal Obstruction with Double-site Small Bowel Intussusception in Patient with Peutz-Jeghers Syndrome

Background: Peutz-Jeghers syndrome (PJS) is one of the intestinal polyposis syndromes that can be associated with multiple polyps throughout the gastrointestinal tract in addition to characteristic circumoral mucocutaneous pigmentations. Case presentation: A 28-year old male patient with known history of PJS presented to the emergency department with acute small bowel obstruction. The patient's history included two previous laparotomies for similar condition. Investigations revealed elevated leucocyte count, multiple air-fluid levels in plain abdominal x-ray, and dilated small bowel loops with pathognomonic target sign in abdominal ultrasonography. Midline exploratory laparotomy was performed and a double-site small bowel intussusception was found and treated with reduction of the proximal intussusception and resection of one meter of the small intestine including both lesions with re-anastomosis of the bowel ends. The patient showed a smooth, uneventful recovery and was discharged with instructions on regular follow-up. Conclusion: Patients with PJS who have history of complicated intestinal polyps are amenable for recurrent episodes of complications which may warrant surgical resection of the affected bowel. Small bowel intussusception should be included to the list of differential diagnoses of intestinal obstruction in patients with PJS and the possibility of more than one lesion should be always considered.