Retrograde jejuno-gastric intussusception following Billroth II gastrectomy with Braun's jejuno-jejunostomy

R Gopal,A Ramesh,V Kate,Ss Prasad Das,R Muthukumarassamy,Tp Elamurugan,S Hage

doi:10.4038/sljs.v31i3.5191

Abstract

Retrograde jejuno-gastric intussusception is a potentially fatal complication of a Billroth II gastrectomy [1, 2]. In all, there are just over 200 cases reported [2]. The condition may present with varied clinical presentations like abdominal pain, vomiting, haematemesis, gastric outlet obstruction, intestinal obstruction, and intestinal gangrene [1,3-6]. To the best of our knowledge, there are no reported cases of haematemesis presenting in a patient with retrograde jejuno- gastric intussusception through a Braun's jejuno-jejunostomy. We present a case that highlights an unusual type of retrograde gangrenous intussusception which occurred across two points of previous anastomosis i.e. jejuno-jejunostomy and gastro-jejunostomy simultaneously. Sri Lanka Journal of Surgery 2013; 31(3):64-65 DOI: http://dx.doi.org/10.4038/sljs.v31i3.5191

Highlights

Retrograde jejuno-gastric intussusception is a potentially fatal complication of a Billroth II gastrectomy [1, 2]
An emergency CT scan of the abdomen revealed a retrograde intussusception of the jejunum into the stomach across the gastro- jejunostomy (Figure.1)
The efferent limb of the jejunum distal to the jejuno-jejunal anastomosis was seen telescoping across the jejuno-jejunostomy (Figure 2), into the stomach, through the gastro-jejunostomy

Summary

Introduction

Retrograde jejuno-gastric intussusception is a potentially fatal complication of a Billroth II gastrectomy [1, 2]. Billroth II gastrectomy and Braun's side-to-side jejuno-jejunal anastomosis for gastric outlet obstruction five years previously, presented to our emergency department with haematemesis for one day. An upper gastrointestinal endoscopy was attempted but visualization was poor due to the presence of altered blood. An emergency CT scan of the abdomen revealed a retrograde intussusception of the jejunum into the stomach across the gastro- jejunostomy (Figure.1). The patient was stabilized and taken up for emergency laparotomy.

Results

Conclusion