A case of retrograde intussusception at Roux-en-Y anastomosis 10 years after total gastrectomy: review of the literature

Abstract

A 63-year-old man, who had undergone total gastrectomy and Roux-en-Y reconstruction for gastric cancer 10 years previously, was admitted to our hospital with complaints of abdominal pain, palpable abdominal tumor, and hematemesis. On admission, the abdominal tenderness was improving and no abdominal tumor was palpable. Mild inflammatory changes and anemia were noted on blood examination. Abdominal computed tomography revealed a tumor with a layered structure in the left abdomen. The patient was diagnosed with intestinal obstruction secondary to intussusception, and surgery was performed. Retrograde intussusception was found at the site of the Y anastomosis. We conducted manual reduction using the Hutchinson procedure. The intestinal color after the reduction was good, and no intestinal resection was required. Postoperative recovery was uneventful, and the patient was discharged 12 days after surgery. Reports of jejunal intussusception after total gastrectomy with Roux-en-Y reconstruction are relatively rare. Here, we report a case of jejunal intussusception after total gastrectomy with Roux-en-Y reconstruction.

Jejunogastric intussusception prone to misdiagnosis as gastric cancer

“…The pathogenesis of JGI remains unclear. But it is thought that mechanical factors and functional factors affect the occurrence of JGI [7]. Functional factors include hyperperistalsis due to hyperacidity or spasm and retrograde peristalsis due to jejunitis or increased abdominal pressure [8].…”

Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: A case report

“…JGI was first reported by Bozzi [ 4 ] in a patient who underwent gastrojejunostomy. Thereafter, there have been <200 cases reported in literature from 2000 to 2010 [ 5 ], and the incidence rate is only 0.07–2.1% [ [1] , [6] , [7] ].…”

“…Various factors cause intussusception after gastrectomy. Kitasato et al [ 7 ] reported that intussusception is caused by both mechanical and functional factors. It is believed that JGI is related to excessive lifting of the jejunal stump, excessive peristalsis, a large anastomosis hole and other factors in Roux-en-Y reconstruction after distal gastrectomy.…”

Laparoscopic diagnosis of retrograde peristalsis and intussusception in Roux‐en‐Y limb after laparoscopic gastrectomy: A case report

“…Intussusception after Roux-en-Y gastric bypass surgery can be seen after both open and laparoscopic procedure (3). Our search yielded only seven reports of jejunojejunal intussusception after gastrectomy in the English-language literature (2,(4)(5)(6)(7)(8)(9).…”

“…Surgery is the most common means of treating intussusception, but unless there is evidence of necrosis at the site of intussusception, resection is not always performed (2,(4)(5)(6)(7)(8)(9). Recurrence may be more likely after manual reduction alone.…”