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.
Our case was a 2-year-old boy who was incidentally diagnosed with anemia during the evaluation of an upper respiratory tract infection. There was no history of hematemesis, melena, or abdominal pain. The child was evaluated by the pediatric gastroenterologist with an upper gastrointestinal endoscopy and was found to have a large sessile gastric polyp that was not amenable to endoscopic resection. Physical examination was insignificant except for a few melanotic spots over the lower lip []. Radiological imaging revealed a large hyper-enhancing mass lesion in the lumen of the stomach, measuring about 8 cm in greatest dimension along with multiple small intestinal polyps. Laparotomy revealed a large sessile polyp involving the greater curvature and posterior wall of the stomach measuring about 10 cm × 8 cm along with multiple small sessile polyps involving the corpus of the stomach sparing the antrum and pylorus, requiring partial gastrectomy []. There were two more polyps, one each in the duodenum and distal jejunum in their antimesenteric border and they could be excised by enterotomy. The child had an uneventful postoperative course. The histopathology revealed the features of tubulovillous adenoma in all the resected polyps. At 36 months of follow-up, the child is asymptomatic and disease-free.