Jejunogastric Intussusception: An Unusual Cause of Hematemesis

Abstract

Jejunogastric intussusception is an uncommon but potentially life-threatening complication of a previous gastrojejunal anastomosis. Although jejunogastric intussusception was first described in 1914, fewer than 200 cases have been reported in the English literature thus far. Awareness of this rare complication would help in early diagnosis and appropriate management. Described here is a case report of a patient who presented with hematemesis due to an acute jejunogastric intussusception associated with gangrene of the intussuscepted jejunum.

Imaging Depiction of Retrograde Jejunogastric Intussusception

“…Plain radiography may occasionally reveal the gastric fluid level with a filling defect. A homogenous density may be seen in the left upper quadrant that represents small bowel in the stomach [8]. A water-soluble upper GI contrast study is however the investigation of choice and reveals a "coiled-spring" appearance (of the jejunal intussusceptum) within the stomach.…”

Retrograde jejunogastric intussusception: a single-institution experience over two decades

“…15 A homogenous soft tissue density at the left upper quadrant may represent small bowel in the stomach. 4,21 A water soluble upper GI contrast study or barium study will reveal "coiled spring" appearance and a central defect in the stomach. 4,15 Upper gastrointestinal endoscopy is diagnostic and therapeutic in selected cases.…”

Intussusception: An anatomical perspective with review of the literature

“…JGI is defined as the prolapse of an anastomosed jejunum into the stomach (retrograde intussusception; Ibegbu et al, 2007). Since 1914, only 200 cases of JGIs have been reported in the literature (Samarasam et al, 2005;Miah et al, 2006). JGI can occur as a complication of partial gastrectomy, gastrojejunostomy, Billroth I surgery, gastrostomy tubes, or any surgery that involves anastomosis between the stomach and the (Warren and Gould, 1900).…”

“…jejunum (Huang and Warshauer, 2003;Kim et al, 2005;Samarasam et al, 2005;Miah et al, 2006;Senol et al, 2009). Lundberg reported a case of JGI in 1922 in a patient with a history of Billroth II resection (Zenooz et al, 2007).…”

“…Lundberg reported a case of JGI in 1922 in a patient with a history of Billroth II resection (Zenooz et al, 2007). JGI has also been associated with long mesenteries, increase in abdominal pressure, and hyperacidity (Kim et al, 2005;Samarasam et al, 2005;Miah et al, 2006). A combination of antegrade and retrograde intussusceptions is even less common, and there have been few reports of such cases in infants (Shekhawat et al, 1998).…”