An 8-year-old boy was referred with four episodes of melena over the past 10 months, fatigability and refractory anemia. There was no history of abdominal pain, loss of weight/appetite, or drug intake. There was no history suggestive of bleeding dyscrasia or family history suggestive of PJ syndrome. On clinical examination, pallor was noted without perioral mucocutaneous pigmentation. Abdominal examination was normal. All hematological and biochemical investigations were within normal limits, except for hemoglobin of 6.5 g/dL, and stool examination positive for occult blood. Ultrasonography of the abdomen, upper and lower gastrointestinal (GI) endoscopy, and Tc99m Meckel's isotope scan were normal. Capsule endoscopy visualized an approximately 2 cm × 2 cm, single, sessile, submucosal polypoidal lesion in the small bowel. Contrast-enhanced computerized tomography (CECT) enteroclysis done a few days later showed small bowel intussusceptions. On laparoscopy, a 20 cm long jejunojejunal intussusception starting 10–15 cm from the duodenojejunal flexure was seen. This was reduced laparoscopically. An intraluminal mass could be appreciated in this segment. No other abnormality was detected. The involved bowel was delivered through the umbilical camera port incision [] and resection anastomosis performed. The histopathological examination of the polyp was suggestive of a PJ polyp []. There were areas of pseudoinvasion in the lamina, submucosa, and muscularis propria.\nHe had an uneventful postoperative period. Although we could not do a specific chromosomal analysis on the patient for PJ syndrome, a family screening was negative. There was no family history of cancers in the GI tract or elsewhere. At 3-year follow-up, he remains asymptomatic with no manifestations of PJ syndrome.
We report a case of a 37 year old man who admitted to our hospital with complaint of occasionally painless rectal bleeding since 8 years ago which had exacerbated with no history of weight loss, abdominal pain, loss of appetite or anal pain. He had no significant past medical history or significant family history of GI malignancy. In physical examination he did not had any pigmentation in mucocutaneous and any abnormal finding in abdomen and rectal examination.\nGastrointestinal endoscopy revealed multiple polyps located in the deuodenum and less than 100 polyps in colon with aggregation in left colon and sigmoid with pathology of juvenile polyposis.\nA barium enema he had mucosal lesions in keeping with polyps in sigmoid (). A laparotomy was performed and multiple giant polyps entire colon was found. Total abdominal proctocolectomy and J pouch ileoanal anastomosis and omentectomy was performed and a diverting ileostomy was inserted. Histopathological evaluations of the polyps revealed hamartomatous polyps in keeping with a diagnosis of Peutz Jeghers syndrome ().