Retrograde jejunogastric intussusception with jejunojejunal intussusception (double telescoping)

Abstract

A 55-year-old woman presented with features of gastric outlet obstruction not responding to conservative treatment at a peripheral hospital. She had gastric surgery 15 years before. On examination, there was a globular mass palpable in the epigastrium. Ultrasound and endoscopy findings were suggestive of retrograde jejunogastric intussusception. After initial resuscitation, emergency laparotomy was undertaken which revealed a jejunogastric intussusception at the previous retrocolic gastrojejunostomy site. After manual reduction of the intussuscepted loop by gentle traction, another segment of the jejunum was seen to be telescoping within this loop. On reduction, this jejunal loop was seen to measure around 20 cm and the apex of the intussusceptum was found to be gangrenous and perforated. Resection of the involved segment was done followed by a Roux-en-y anastomosis to restore the continuity.

Primary jejunogastric intussusception: A case report and review of the literature

“…Various factors have been incriminated such as hyperacidity long afferent loop, jejunal spasm with abnormal motility, increased intra-abdominal pressure, retrograde peristalsis, etc. Probably, retrograde peristalsis, which can occur in normal people prior to gastric surgery, seems to be accepted as the cause of type 2 jejunogastric intussusception by most authors [12] .…”

“…If the intussusception is gangrenous, resection and revision of anastomosis provide the correct treatment [12] .…”

Jejunogastric intussusception after Whipple procedure with B-II reconstruction: a case report

“…JGI can occur at any gastric anastomosis including following gastrojejunal anastomosis and Braun's anastomosis in Billroth II reconstruction, and at the Y anastomosis site in Roux-en-Y reconstruction [7]. The primary disease prior to gastric surgery can include gastric cancer or gastric ulcer [8][9][10][11][12][13]; however, with increasing numbers of bariatric surgeries, the incidence of JGI is also increasing [14]. To our knowledge, ours is the first report of JGI after Whipple's procedure.…”

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

“…Severe haemetemesis can result from secondary ulceration and due to compromised jejunal vascular supply. 3,19 Features of gastric outlet obstruction or high intestinal obstruction can be present. Epigastric tenderness and a palpable abdominal mass and signs of high intestinal obstruction are additional findings on examination.…”

“…Surgical options include manual reduction, resection of gangrenous bowel, anastamotic revision and take down of anastamosis and conversion to Roux-en-Y reconstruction depending on intra-operative findings. 14,19 Reduction by gentle traction with or without opening the stomach should always be attempted. When there is strangulation with gangrenous bowel resection will be mandatory.…”