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

Abstract

Background: Intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB) and extremely rare after near total gastrectomy. Case Presentation: 46-years-old woman (BMI=40 kg/m2 , co-morbidity: hypertension) operated about seven months before of near total gastrectomy (for distal gastric cancer) with a small bowel resection with Roux and Y gastric reconstruction , presented epigastric pain after meals, alvus alterations lasting by a week, vomiting in the last days with leukocytosis and transaminase and amylase increase. The CT scan showed peri-hepatic fluid, gastric, duodenal and jejunal dilatation, a "target like imagine" of jejuno-jejunal anastomosis with small bowel air-fluid levels, normal intestinal loop downstream the jejuno-jejunal anastomosis. During laparoscopy we discovered ischemia of common jejunal tract intussuscepted into the jejuno-jejunal anastomosis. The common ischemic intestinal tract and the anastomosis were resected “enbloc” and jejuno-jejunal anastomosis was performed again. Conclusion: The symptoms of small bowel intussusception after near total gastrectomy are not specifics but the risk of severe complications requires an early diagnosis and treatment. According to literature data, CT-scan is the gold standard for the diagnosis but in unclear cases it is mandatory an early laparoscopic exploration to confirm the clinical suspicion and to perform the appropriate treatment.