Publication Date

11-2025

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Abstract

Previously healthy 11-year-old female, newly diagnosed Peutz-Jeghers Syndrome (PJS) confirmed by genetic testing STK11 PV (c.464+1dupG) underwent double balloon enteroscopy (DBE) after small bowel capsule showed multiple small intestinal polyps including >1.5 cms diameter. Pre-procedure, she completed a two-day MiraLAX clean out with >10 x 17g doses of MiraLAX each mixed in 6-8oz of water and other clear liquids. DBE completed with resection of 17 total small intestinal (SI), jejunal and ileal polyps. Procedure lasted approximately 4hrs and 5L of sterile water was used for underwater technique and irrigation.Sterile water was used for copious irrigation needed for direct visualization, and increased buoyancy of SI polyps in compliance with scope manufacturer recommendations (IFU). Patient was admitted secondary to number and size of polyps removed. Six hours post-procedure patient had hematemesis followed by a generalized tonic-clonic seizure. Abortive medications given and severe hyponatremia noted with serum sodium of 119mEq/L . Patient transferred to the ICU and treated with 3% hypertonic saline and sodium normalized over several hours. Patient discharged home with several stable sodium levels and no neurologic sequelae. This case represents the rare but potentially life- threatening complication of post-endoscopic symptomatic hyponatremia in a previously healthy patient. In adults, this is typically associated with excessive free water intake, older age, or in the context of unknown underlying comorbidities.

Disciplines

Gastroenterology | Pediatrics

Notes

Presented at the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2025 Annual Conference; Chicago, IL; November 5-8, 2025.

Symptomatic Severe Hyponatremia: A Rare Complication of Double Balloon Enteroscopy

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