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

Abstract

Introduction: Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment.

Presentation of case: An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high-grade fever occurred on postoperative day 12, after which oral intake became difficult.

Discussion: Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception.

Conclusion: Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary.

Keywords: Distal gastrectomy and Roux-en-Y reconstruction; Jejunogastric intussusception.

Fig. 1

Upper gastrointestinal series showing a dilated gastric pouch with air-fluid level (A) and an elevated lesion projecting into the stomach at the anastomosis site (B). No passage of the anastomosis site was obeserved even when applying pressure onto the stomach.

Fig. 2

Gastrointestinal endoscopy showing an elevated lesion with ring-like folds protruding, and with a green caterpillar-like appearance, through the anastomosis site into the remnant stomach (A). The anastomosis site was stenosed, and an endoscope could not pass through it (B).

Fig. 3

Abdominal computed tomography scan showing the elevated lesion protruding to the remnant stomach (A). A metallic piece which seems to be linear stapler was recognized inside the elevated lesion (B).

Fig. 4

Macroscopically, the jejunal stump was inverted into the remnant stomach and showed a polypoid lesion resembling a spring coil (A). Microscopically, the intestinal mucosa, submucosa, and muscularis propria were completely convered and foreign body granulomatous reaction with suture materials was observed in the center of the leading point (B).