Retrograde jejunogastric intussusception following Braun’s jejunojejunostomy

Abstract

Jejunogastric intussusception is a rare long term complication of Billroth II gastrectomy. The case reported here is a 50 year old man with history of a Billroth II gastrectomy and Braun's side-to-side jejunojejunal anastomosis who presented with hematemesis. On abdominal examination, there was a mass in the left iliac fossa. Computed tomography scan showed a retrograde jejunogastric intussusception across the gastrojejunostomy. On laparotomy, a retrograde intussusception of the distal jejunum through the jejunojejunal anastomosis and across the gastrojejunostomy with a gangrenous intussusceptum was found. The jejunojejunal anastomosis was taken down, the gangrenous segment was resected and bowel continuity was restored with two jejunojejunal anastomoses, proximal and distal to the gastrojejunostomy. The gastrojejunostomy was preserved. This case brings out an unusual type of retrograde gangrenous intussusception which occurred at two points of a previous anastomosis, i.e., jejunojejunostomy and gastrojejunostomy simultaneously, which could be managed with jejunal resection.

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

“…Our patient had an exacerbation of the symptoms characterized by the appearance of vomiting and an alteration of transaminases and amylases, according to the Literature but without specific symptoms of intussusception. All Authors agree with the importance of the CT-scan as the gold standard for the diagnosis with an accuracy of 80% [4,5,14,17,26]. CT specific signs are: "target" imagine which confirms the presence of bowel wall intussuscepted inside the tract that appears expanded the "telescope" sign when the intussuscepted bowel seems a telescope into the adjacent distal intestinal loop (Figure 3 & 6) [27][28].…”

“…Intussusception after near total gastrectomy is a rare cause of intussusception, with an increasing incidence [2,3]. It is usually associated with lesions defined "lead point", such as cancer, polyps, adhesion it is defined anterograde or retrograde by isoperistaltic or antiperistaltic behavior of the intestinal loop intussuscepted [4][5][6][7][8][9][10][11][12][13][14]. Its pathophysiology after near total gastrectomy is still unclear.…”

Jejunogastric intussusception presented with hematemesis: A case presentation and review of the literature

“…Furthermore, endoscopic reduction of JGI has a risk of recurrence and surgery remains the treatment of choice [4,7,9]. Emergency surgical intervention is necessary in most cases and can prevent clinical deterioration [10]. Surgery for JGI can be simple reduction or resection and refashioning of the gastroenterostomy.…”

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

“…1 Literature review showed that just over 200 cases have been reported, most of them being case reports and small series. [2][3][4][5] The reported incidence is less than 0.1% to 0.15%. 7,8 Retrograde intussusception was also reported in patients after Billroth-I reconstruction, Billroth-II reconstruction, previously placed gastrostomy tubes, pancreaticojejunostomy and total gastrectomy with Roux-en-y-anastomosis.…”

“…Few authors describe Type IV, which consists of over intussusception through a braun side-to-side jejunojejunal anastomosis. 3,5 The etiopathogenesis and mechanism of JGI are unclear and poorly understood. The major theories suggested are functional and mechanical.…”