Laparoscopic Duodenal Polypectomy with Intraoperative Endoscopy in Peutz-jeghers Syndrome

We present a video of a laparoscopic resection of a 6cm hamartomatous polyp arising from the 3rd part of the duodenum and intraoperative endoscopy in a 15 year old female with Peutz-Jeghers syndrome.

The patient has a history of multiple small hamartomatous polyps removed endoscopically. She now presents with symptoms of intermittent postprandial abdominal pain. At upper endoscopy she was found to have a large pedunculated polyp arising from the third part of the duodenum which could not be endoscopically resected.

A combined laparoscopic and endoscopic procedure was elected.

Initial laparoscopy demonstrated a chronically dilated duodenum and proximal jejunum. An intraluminal mass was encountered in the proximal jejunum with a transition to normal jejunum distally. The remaining small bowel appeared normal.

A transverse enterotomy was made in the dilated jejunum and the pedunculated polyp resected.

An intraoperative upper endoscopy/ push enteroscopy was performed which demonstrated the base of the polyp in the duodenum and the closed enterotomy in the jejunum.

Patients with benign polyposis syndromes often require multiple intestinal operations during their lifetime. The laparoscopic approach can minimize the adverse effects of multiple surgeries. Intraoperative endoscopy helps to assess the adequacy of resection, hemostasis and closure of the enterotomy or anastomosis.

Session: Podium Video Presentation

Program Number: V039

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