A Case of Intussusception After Laparoscopic Total Gastrectomy

Abstract

A man in his 60s who underwent laparoscopic total gastrectomy and Roux-en-Y reconstruction for gastric cancer six years previously visited our hospital with the complaints of left lower quadrant pain and vomiting. The target sign was identified in the lower left abdomen on abdominal ultrasonography and CT. We diagnosed intussusception at the Y-leg anastomosis and performed emergency surgery. The jejunum, extending from the ligament of Treitz to the Y limb, exhibited a reddish-brown color and dilatation. The blind end of the Y limb was adherent to the elevated jejunum, forming the advancing segment, causing obstruction. We reduced the intussusception using the Hutchinson technique. We assumed that the extended blind end of the Y limb was the cause of the obstruction, and excised the blind end and buried the stump. The patient complained of vomiting after meals; an oral small bowel contrast study conducted to identify the cause revealed no recurrence of the intestinal obstruction or passage impairment. The patient was discharged on the 21st postoperative day. We deemed it desirable not to elongate the blind end during the Roux-en-Y reconstruction and opted to bury the stump.