Abstract
A malnourished 78-year-old male was admitted to our hospital with a diagnosis of advanced gastric and lung cancers.
Gastroduodenoscopy also revealed a superficial esophageal cancer. Radical treatment for the malignancies was planned. However, the patient's condition worsened because of repeat episodes of aspiration pneumonia and poor nutritional intake.
Nutritional support was administered, and Stamm jejunostomy was performed. Insertion of the jejunostomy tube was uneventful ; the bowel wall was very thin, and no palpable tumor or adhesions were found in his intestine.
After the operation, he developed vomiting and abdominal pain. Ten days after surgery, abdominal contrast-enhanced CT was performed ; bowel wall thickening around the inserted jejunostomy tube was noted. A diagnosis of intussusception was made and treated non-operatively. The patient's symptoms were relieved immediately, but he subsequently developed vomiting and abdominal pain.
Radiological examination showed intussusception in the same portion of his abdomen, and an emergency operation was performed.
During surgery, a 20-cm-long intussusception distal from the tube insertion was found. It was impossible to relieve the intussusception via the Hutchinson maneuver because of the presence of a firm adhesion between the diseased bowels ; blunt dissection was needed. There were no signs of bowel injury, ischemia, or necrosis. The patient's postoperative course was uneventfull.
