Retrograde jejunogastric intussusception: a single-institution experience over two decades

Abstract

Background: Jejunogastric Intussusception (JGI) after gastrojejunostomy is a rare and serious complication. Methods: Retrospective analysis of patients with a diagnosis of JGI was analyzed from November 1995 to October 2015 at our institute. Patient data regarding clinical presentation, investigations, surgical procedures, outcomes and follow-up were obtained from medical records. Results: There were 13 cases of JGI. All were males. The mean age at presentation was 54.69 years (range 46-62). All patients presented with hematemesis or coffee ground vomiting. The time duration from gastrojejunostomy was 5 to 25 years. Upper gastrointestinal endoscopy was diagnostic in 10 cases. In 3 patients, 2 were misdiagnosed as bleeding tumour and as polyp in one patient during endoscopy. All patients underwent surgical management. Most commonest type was Type II (efferent loop) seen in 10 patients; Type III (combined type) was seen in 2 patients. One patient had Type I (afferent loop). Two patients had postoperative wound infection. On median follow-up of 6 years, there were no recurrences. Conclusions: JGI is a rare complication after gastrojejunostomy. Upper gastrointestinal endoscopy is the most accurate diagnostic technique when performed by an experienced endoscopist. Emergency surgery still remains the main stay of treatment. A high index of suspicion is required for diagnosis in patients with prior history of gastrojejunostomy.