A CASE REPORT OF INTUSSUSCEPTION AT BRAUN'S ANASTOMOSIS OCCURRING AFTER TOTAL GASTRECTOMY

Abstract

A case of intussusception at Braun's anastomosis occurring 12 years after total gastrectomy is reported.The patient was a 59-year-old man who had a history of total gastrectomy for gastric cancer. The main complaints were severe abdominal pain and hematemesis with acute onset. Ultrasonography revealed the “multiple concentric ring sign” preoperatively, and established the diagnosis as intussusception. A comprehensive study of the results of CT, fluorescopy and endoscopy of the digestive tract raised a suspicion of intussusception at Braun's anastomosis.The findings of laparotomy showed that total gastrectomy by the antecolic B-II method and Braun's anastomosis had already been performed, and the problem was an ascending three-pipe intussusception which developed at Braun's anastomosis 20 cm from the anus. On account of intestinal necrosis, enterectomy was performed.In the diagnosis of intussusception after gastrectomy, it is important to keep in mind the presence of this condition. Moreover, ultrasonography is considered to be an extremely usefull method of examination, since findings peculiar to intussusception, such as “multiple concentric ring sign”, are obtained through it.