Jejunogastric intussusception.

Abstract

Jejunogastric intussusception is a rare complication of gastroenterostomy and may be serious enough to produce alarming clinical symptoms. The following case, although it had a rather typical clinical course, presents a few interesting facets in respect to the x-ray findings and presurgical history. Report of Case A 55-year-old white male had undergone a right radical mastectomy for carcinoma eight years earlier. Later he was found to have carcinoma of the larynx with metastasis to the left lung, for which he received radiation therapy. His present admission was prompted by the occurrence of epigastric pain and some vomiting in the mornings. An upper gastrointestinal tract study showed what appeared to be a bezoar in the stomach (Fig. 1), but no free acid was present. Repeated lavage and re-examination showed essentially the same findings. Exploratory laparotomy revealed a mass of undigested string beans in the stomach, adherent to the mucosa, which was relatively coarsened. No evidence of malignant infiltration was observed. An antecolic gastrojejunostomy was performed. Two days following operation the patient vomited profusely, and vomiting continued for several days. Abdominal distention was relieved by gastric suetion. Fluids were given intravenously. The temperature rose intermittently, but the general condition was satisfactory. An x-ray study of the upper gastrointestinal tract approximately two weeks after the operation revealed a filling defect in the greater curvature of the stomach at the area of the anastomosis, with some edema of the gastric mucosa (Fig. 2). The mucosal folds had an irregular to occasionally spiral appearance. On the eight-hour film the afferent loop of the anastomosis appeared dilated and redundant (Fig. 3) with considerable retention in the stomach and duodenal bulb. There was no evidence of opaque medium in the efferent loop. These findings suggested a diagnosis of jejunogastric intussusception, and surgical exploration was undertaken. The afferent loop was patent and slightly dilated. The efferent loop was collapsed, and a segment of the omentum was adherent about the anastomosis. A moderate degree of intussusception of the anastomosed jejunum into the stoma was observed. In addition, there was incomplete volvulus of the efferent loop. The obstruction was released and the patient made an uneventful recovery. He was discharged from the hospital the tenth postoperative day feeling well. He died at home eight months later, apparently from metastatic cancer. Discussion Considering the frequency of gastric surgery, jejunogastric intussusception is a rare complication, or at least infrequently recognized, as indicated by the number of proved cases in the literature (about 100). Until 1948 only 12 cases were diagnosed roentgenographically.