Jejunogastric Intussusception Research Articles

Jejunogastric intussusception associated with jejunojejunal intussusception (double telescoping) occurring 20 years after gastrojejunostomy.

Jejunogastric intussusception (JGI) is a rare but potentially lethal complication following gastrectomy or gastrojejunostomy surgeries. Diagnosis of this condition can be challenging due to its rarity and non-specific symptoms. This article presents a case report of a 60-year-old male with a history of trans mesocolic gastrojejunostomy who developed acute symptoms of JGI. The patient presented with acute epigastric pain, vomiting, and hematemesis. Physical examination and laboratory tests indicated dehydration, tachycardia, and leukocytosis. Computed tomography (CT) revealed intussuscepted loops within the stomach. Emergency laparotomy was performed, and the intussusception was manually reduced without the need for resection. The patient recovered well and was discharged five days post-surgery. Retrograde jejunogastric intussusception is a rare complication, often occurring years after gastric surgery. It can be classified into acute and chronic forms, with the former presenting with intense pain and potential hematemesis. The condition can arise in different surgical contexts and even spontaneously. The cause of JGI remains unclear, but factors such as hyperacidity, abnormal motility, and increased intra-abdominal pressure have been implicated. Diagnosis can be made through endoscopy or alternative imaging modalities such as CT. Surgical intervention is the treatment of choice, with various options available based on intraoperative findings. Retrograde jejunogastric intussusception is challenging to diagnose and treat due to its rarity and lack of understanding of its causes. Imaging techniques and endoscopy play important roles in diagnosis, while surgery remains the primary treatment option. Vigilance is necessary among medical professionals to consider JGI in cases of acute abdominal pain and vomiting following gastric surgery, allowing for prompt diagnosis and intervention to prevent bowel necrosis. Further research is needed to establish optimal surgical strategies and evaluate recurrence rates.

Retrograde jejunogastric intussusception

Retrograde intussusception pertains to the invagination of the intussusceptum in a direction opposite to normal peristalsis. Jejunogastric intussusception (JGI) is an infrequent complication linked to procedures such as gastrojejunostomy, Billroth II gastrectomy, and Roux-en-Y anastomosis. There are four types of JGI based on the type of intussuscepted bowel loop and two types based on clinical presentation. In its acute form, JGI presents as severe intestinal blockage, a mass in the left hypochondriac region, and the occurrence of hematemesis. In a chronic situation, it leads to the recurrent episodes of feeling full in the upper abdomen and experiencing vomiting because of intermittent and reversible intussusception. The gold standard investigation for diagnosis is a contrast-enhanced computed tomography (CECT) scan. Here, we describe a case of retrograde JGI in a patient who presented with the complaints of hematemesis. The CECT scan revealed the invagination of jejunal bowel loops into the stomach. This condition was treated surgically.

Single-balloon enteroscopy-assisted reduction of jejunogastric intussusception after Billroth II gastrectomy (with video)

Single-balloon enteroscopy-assisted reduction of jejunogastric intussusception after Billroth II gastrectomy (with video)

Strangulated Jejunogastric Intussusception: A Unique Complication Following Billroth II Reconstruction.

Strangulated Jejunogastric Intussusception: A Unique Complication Following Billroth II Reconstruction.

Primary jejunogastric intussusception: A case report and review of the literature.

IntroductionJejunogastric intussusception following gastric surgery is a rare complication that, if not diagnosed early, can have catastrophic outcomes.Presentation of caseWe have reported a case, never described previously, of an acute spontaneous retrograde JGI, presenting with obstruction and hematemesis, in a 70-year-old woman who has never, previously, undergone abdominal surgery.DiscussionAs in all cases of intestinal intussusception, early diagnosis is important for acute JGI as mortality rates increase from 10% when the intervention occurs within 48 h. to 50% if treatment is delayed for 96 h.The diagnosis of JGI can be determined with many imaging studies, such as endoscopy, ultrasonography (US), barium stadium and CT scan.Although JGI, up to now, has been described as a rare complication after any type of gastric surgery, this disease must, however, be suspected also in patients who have never undergone abdominal surgery, if they present with non-sedable abdominal pain associated with signs of high intestinal obstruction and hematemesis.ConclusionOur hope is to add to the available literature to aid physicians in their diagnostic work-up and in developing management plans for similar cases occurring in the future.

Retrograde Jejunogastric Intussusception and Novel Reduction

Retrograde Jejunogastric Intussusception and Novel Reduction

Laparoscopic Management of Retrograde Jejuno-Gastric Intussusception: a Case Report

Jejuno-gastric intussusception is a rare but lethal complication of gastric surgeries with a reported incidence of 0.15%. A high index of suspicion is required to diagnose this condition in a patient with a history of gastric surgery. With advances in minimal access surgery, reduction of the intussusceptum is possible through laparoscopy or endoscopy. We present an elderly male who had undergone a Billroth II procedure before 27 years. The patient was diagnosed with jejuno-gastric intussusception based on ultrasound and endoscopic findings. The patient was successfully managed under laparoscopy.

Jejunogastric intussusception after Whipple procedure with B-II reconstruction: a case report

BackgroundJejunogastric intussusception (JGI) is a rare but severe complication after gastric surgery. JGI can occur from a few days to 55 years postoperatively and has a reported incidence of < 0.1% in patients who undergo gastric surgery. We firstly report a male patient with duodenal cancer who underwent Whipple’s procedure with side-to-side gastrojejunostomy and who subsequently developed JGI. A literature review is provided.Case presentationA 68-year-old man was admitted to our emergency department with left upper quadrant abdominal pain and hematemesis of 4 h’ duration. He had undergone Whipple’s procedure (duct-to-mucosa pancreaticojejunostomy and side-to-side gastrojejunostomy) with B-II reconstruction for duodenal papillary adenocarcinoma 5 years earlier. His vital signs were stable with a blood pressure of 163/93 mmHg, temperature of 37.0 °C; and heart and respiratory rates of 86 per/min and 20 per/min, respectively. Physical assessment showed mild tenderness in the left upper quadrant, only. A complete blood count showed white cell and platelet counts of 11.69 × 103/L and 196 × 103/L, respectively, and a hemoglobin level of 13.5 g/L. Abdominal computed tomography (CT) suggested a retrograde intussusception of the intestines into the stomach with dilatation of the remnant stomach. The patient immediately underwent exploratory laparotomy, which revealed a 20-cm retrograde efferent limb at the remnant stomach that had travelled through the previous gastrojejunostomy. There was no evidence of malignancy. We manually reduced the intussuscepted loop using gentle traction, and the viability of the intestinal loop was preserved. The patient had an uneventful postoperative recovery.ConclusionJGI is a rare but potentially fatal complication after gastric surgery, especially following Whipple’s procedure. Early diagnosis and treatment are crucial, and surgery is considered the most effective treatment for JGI.

A rare case of internal herniation with retrograde jejunogastric intussusception into the stomach

AbstractJejunogastric intussusception (JGI) is a rare long‐term complication of Billroth II gastrectomy. It presents potentially lethal complication of gastrectomy or gastrojejunostomy which can occur any time after a gastric operation. Delayed diagnosis can lead to high morbidity and even mortality. Prompt surgical intervention is mandatory after early diagnosis. Endoscopy and abdominal computed tomography (CT) scanning are the main diagnostic tools. For gastric surgery patients who later experience sudden onsets of epigastric pain, vomiting, or subsequent hematemesis, JGI should be considered. A 77‐year‐old man who had a Billroth II gastrectomy 30 years prior to admission presented to our emergency department due to multiple episodes of epigastric colicky pain and hematemesis. He underwent esophagogastroduodenoscope and an abdominal CT scan. We provided a systemic image description of a rare case of internal herniation with retrograde JGI into the stomach. The patient received emergent laparotomy and resection of the efferent loop of the jejunum with the gangrenous segment. He was discharged 10 days after admission. JGI is a rare but potentially fatal disease. Early diagnosis and surgical treatment are important to avoid subsequent high mortality.

Jejunogastric intussusception after distal gastrectomy with Billroth II reconstruction

Intussusception in adults is uncommon. We present a rare case of intussusception of efferent jejunum through gastrojejunostomy in a patient who underwent distal gastrectomy with Billroth II reconstruction. Revision total gastrectomy was performed successfully. High index of suspicion and early diagnosis is crucial as delayed intervention can lead to a mortality rate of 50%.

Case Report of Jejunogastric Intussusception Developing after Distal Gastrectomy with Roux-en-Y Reconstruction

症例は78歳，女性．胃癌（pT3N0M0，Stage IIA）に対して幽門側胃切除術を施行．再建はRoux-en-Y法（後結腸経路）で，胃空腸吻合は自動縫合器による側々吻合で行った．術後4日目で経口摂取を開始したが，術後12日目に嘔吐を認めた．胃透視で胃空腸吻合部の通過障害を認めた．内視鏡検査では挙上空腸の盲端側空腸が胃内に突出して腸重積となっており，通過障害の原因と考えた．内視鏡的整復は困難で，経鼻胃管を留置して保存的加療を試みたが改善なく，術後25日目に再手術を施行．手術は残胃前壁を切開し，胃内で腸重積部を自動縫合器で切離して胃切開部を縫合閉鎖した．再手術後に通過障害は改善し，再手術後47日目で退院．Roux-en-Y再建後の胃空腸吻合部の腸重積の報告例は3例と稀で，いずれも再手術で残胃切除および再建が行われていた．今回，再手術で腸重積部の切除のみで残胃切除を回避しえた1例を経験したので報告する．

Jejunogastric intussusception presented with hematemesis: A case presentation and review of the literature

SummaryJejunogastric intussusception (JGI) is a rare but life‐threatening complication of gastrectomy. It is a complication of previous surgery on the stomach, such as Billroth II gastrectomy, Roux‐en‐Y anastomosis, and gastrojejunostomy. Early diagnosis is important but difficult in acute JGI. Emergency surgical intervention is necessary in most cases and can prevent clinical deterioration. We report such a case that presented with hematemesis.Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

Jejunogastric intussuception presenting as an epigastric mass: A rare case report

Jejunogastric intussusception is a potentially lethal complication of gastric surgery intussusceptions that can occur in any patient who has had a gastrojejunostomy. The diagnostic triad consists of high intestinal obstruction, left hypochondriac mass and hematemesis. On abdominal examination there may be left upper quadrant tenderness and guarding, and occasionally a mass may be felt. Often the mass is concealed by the rib cage and the guarding. Because the lesion is intraluminal, there is no peritoneal irritation and ileus is a late sign. This complication may occur at a variable period after original gastric operation. The treatment of acute variety of jejunogastric intussusception is prompt surgery. Delay in surgery beyond 48 hours is associated with an approximately 50% mortality.

A Rare Complication of Gastrojejunostomy: Jejunogastric Intussusceptions

Jejunogastric intussusception (JGI) is a rare life-threatening complication of gastrectomy or gastrojejunostomy. Diagnosis of this condition has been reported to be difficult in most of the cases. An early diagnosis and urgent surgical intervention are essential to avoid mortality. We present a case of the characteristic US and CT findings of this entity.

Retrograde Jejunogastric Intussusception (RJGI): A Life- Threatening Complication after Gastric Bypass Surgery

Retrograde jejunogastric intussusception (RJGI) after gastric bypass surgery is a rare but potentially life threatening complication. This complication may develop after simple gastrojejunostomy, after lower partial resection of stomach with gastrojejunostomy (Billroth-II gastric surgery) or after Roux-en-Y gastric bypass. Among the three anatomic type of jejunogastric intussusception (JGI), type-II is the commonest variety. The acute form is a surgical emergency. Mortality rate is very high. Little is known about the mechanism but many literatures indicate abnormal motility may be a cause. A 50 year old male presented to us with a three month history of repeated vomiting and one day of upper mid-abdominal pain. He had a history of gastric bypass for pyloric stenosis 12 years back. Diagnosis was confirmed by upper GI endoscopy. At laparotomy type II retrograde jejunogastric intussusception was identified. En-block resection of affected segment of jejunum and lower part of the stomach was done followed by Roux-en-Y reconstruction. RJGI is a rare complication of gastric bypass surgery. Early diagnosis is imperative. High index of suspicion is therefore important. Barium meal X-ray, ultra sonogram, enhanced CT scan occasionally be diagnostic, but endoscopy is certainly diagnostic in experienced hand. Laparotomy is mandatory. Surgical options include simple reduction, en-block resection and/or plication.J Bangladesh Coll Phys Surg 2015; 33(3): 161-165

Retrograde jejunogastric intussusception; varied clinical and endoscopic presentation: A cases series

AbstractRetrograde jejunogastric intussusception is a rare complication of gastric surgery. Approximately 250 cases have been reported till now. It has varied clinical and endoscopic presentations. Since gastrojejunostomy with vagotomy are on a declining trend, it is extremely rare to come across such a complication. The condition can be acute and life threatening or chronic and disabling. We report four such cases with different endoscopic and clinical presentations.

A retrograde intussusception of Roux-en-Y gastrojejunostomy: an unusual cause of haematemesis

Jejunogastric intussusception is a rare complication following gastric surgery and is estimated to occur in less than 0.1% of patients. It is a potentially fatal complication, if prompt diagnosis and surgical intervention is not performed immediately. Here, we present a case of retrograde jejunogastric intussusception who presented with haematemesis. Patient was diagnosed by an upper GI endoscopy. The diagnosis, management and the etiological theories of jejunogastric intussusception following gastric surgery are discussed here .

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

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.

Gangrenous Jejunogastric Intussusception: Is Reduction advisable?

We have read the article Jejunogastric intussusception with internal herniation in the stomach by Khanna S, Kumar D, Khanna R, and Gupta SK [1] with interest. The authors have described a case, wherein a gangrenous jejunogastric intussusceptions (JGI) was reduced by gentle traction and about 30 cm of gangrenous bowel was subsequently resected. Presence of gangrene in the intussusceptions is an important consideration in deciding the operative procedure in individual patient and it also affects prognosis. Reduction of gangrenous JGI is difficult, often impossible, and even inadvisable. Rupture of the jejunal wall may occur at the site of necrotic areas [2] and cause peritoneal contamination.

English

INTRODUCTION: Jejunogastric intussusception is a rare but potentially very serious complication of gastrectomy or gastroenterostomy described in 1941 by Bozzi.1 Only about 200 cases have been reported in literature to date. Diagnosis of this condition is difficult in most of the cases. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. Since gastrojejunostomy with vagotomy are on a declining trend, it is extremely rare to come across such a complication.2 This paper reports a case of retrograde jejunogastric intussusception in a patient who underwent gastrojejunostomy 20 years back for bleeding peptic ulcer.