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

Abstract

The cause of jejunojejunal intussusception, a rare complication after Roux-en-Y gastric surgery, remains unclear. Here, we present a case of retrograde jejunojejunal intussusception that occurred after laparoscopic distal gastrectomy with Roux-en-Y reconstruction. A 51-year-old woman who had undergone laparoscopic distal gastrectomy and Roux-en-Y reconstruction for early gastric cancer 6 years previously was admitted to our hospital with abdominal pain. Abdominal CT revealed the "target sign," and she was diagnosed as having small bowel intussusception. Laparoscopic surgery resulted in a diagnosis of retrograde intussusception of the distal jejunum of the Roux-en-Y anastomosis with retrograde peristalsis in the same area. The Roux-en-Y anastomosis site and intussuscepted segment were resected laparoscopically. To the best of our knowledge, this is the first report of laparoscopic diagnosis of retrograde peristalsis in the distal jejunum of a Roux-en-Y anastomosis. Additionally, relevant published reports concerning this unusual condition are discussed.

Common Jejunal Tract Intussusception into the Jejuno-Jejunal Anastomosis as Long-Term Complication after near Total Gastrectomy for Distal Gastric Cancer

“…It may include the simple intussusception reduction with or without the plication and the anastomotic resection with intestinal stump re-anastomosis [5,6,15]. Manual reduction with or without plication/pexy procedure has been described in many studies [3,29,30]. The resection must be conducted when there are signs of bowel necrosis.…”

Retrograde intussusception post-total gastrectomy and small bowel resection with Roux-en-Y gastric bypass reconstruction

“…Intussusception is often difficult to diagnose because of its variable gastrointestinal symptoms and presentation. Common symptoms include non-specific abdominal pain, nausea and vomiting and occasionally symptoms of bowel obstruction, such as constipation or altered bowel habits [8]. Symptoms may vary in acuity and severity [5].…”

“…Some authors have estimated intussusception to be a cause of 10.8% of small bowel obstructions post RYGB [8]. Given the rapid increase in the rate of bariatric surgery, intussusception is becoming an increasingly prevalent post-op complication, despite its rare incidence post-RYGB [4].…”

“…Currently, there is no consensus on definitive treatment for intussusception post-RYGB. Manual reduction with or without plication/pexy procedure has been described in many previous studies [4,5,8]. It was recommended that resection should be conducted when there are signs of bowel necrosis.…”

“…It has been noted there is a higher incidence of intussusception in cases of RYGB for weight loss compared to cases of RYGB with gastrectomy [8,9]. This may be contributed to by thinning of the mesentery associated with weight loss, which increases the mobility and instability of bowel, leading to a higher chance of intussusception [5,9,12].…”