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.

Keywords: Retrograde; Intussusception; Billroth II gastrectomy; Jejunojejunostomy

Core tip: Retrograde jejunojejunal and jejunogastric intussusceptions are rare. The occurrence of retrograde intussusception across two anastomoses has not been reported in the literature. A high index of suspicion and timely investigations like an esophagogastroscopy or a computed tomography scan will help to clinch the diagnosis early. Emergency surgical intervention can help to prevent clinical deterioration and save the life of the patient. We would like to emphasize the fact that a high index of clinical suspicion should be maintained in patients with gastroenteric anastomosis who present with hematemesis for the possibility of a retrograde jejunogastric intussusception; the results can be gratifying.