Unusual complication in patient with Gardner’s syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

ARTICLE HIGHLIGHTS

Case characteristics

A 37-year old cachectic male patient was referred to our center with lower gastrointestinal bleeding.

Clinical diagnosis

Gardner’s syndrome (GS), lower gastrointestinal bleeding due to gastrointestinal polyposis.

Differential diagnosis

Bleeding due to colorectal cancer, bleeding due to colonic polyposis.

Laboratory diagnosis

Hemoglobin: 8 g/dL, creatinine: 2.9 mg/dL, albumin: 2.1 g/dL, total bilirubin: 6.3 mg/dL.

Imaging diagnosis

Conventional celiac and mesenteric angiographies that were performed to detect the hemorrhagic focus showed no extravasation that was indicative of bleeding.

Pathological diagnosis

Poorly-differentiated adenosquamous carcinoma of the colon, colorectal polyposis, duodenal polyposis, desmoid tumor.

Treatment

Resection of the distal duodenum and proximal jejunum, latero-lateral duodenojejunal anastomosis, total abdominal colectomy with end ileostomy, distal rectal stump closure, resection of the desmoid tumor-like lesions.

Related reports

To the best of our knowledge, no case of GS has ever been reported in the English language medical literature that presents with gastrointestinal perforation and bleeding.

Experiences and lessons

Although GS is a rare condition, it should be taken seriously since it may cause colorectal cancers until the age of 40. Therefore, close follow-up of GS patients and prophylactic surgery during early stages of GS are the most appropriate approaches. Patients who are diagnosed with upper gastrointestinal polyps should be closely examined by endoscopy. The case presented here clearly demonstrates that serious life-threatening complications like tumor perforation and massive bleeding may develop in neglected GS cases.