Jejunal Intussusception after Harvesting a Free Jejunal Autograft—A Case Report—

Abstract

Intussusception in adults is a relatively rare disease, which is attributed to organic causes in 90% of the cases. We present herein a case of adult intussusception following harvesting of a free jejunal autograft. A 78-year-old man had undergone endoscopic submucosal dissection (ESD) for the treatment of early gastric and esophageal cancer. One year after ESD, the patient was diagnosed with upper esophageal carcinoma, for which pharyngolaryngoesophagectomy was performed. To restore esophageal continuity, a free jejunal autograft was harvested, and gastrostomy was performed. On the third postoperative day, the patient started vomiting. A gastric drainage via the gastrostomy was initiated; however, the amount of discharge did not decrease. On the 15th postoperative day, gastrointestinal fiberscopy was performed, but failed to show organic stenosis. However, the upper gastrointestinal series and computed tomography performed on the 19th postoperative day, showed stenosis of the jejunal anastomosis. Finally, a diagnosis of intussusception was made, and a reoperation was performed on the 28th postoperative day.
Intraoperatively, the proximal jejunum was revealed to intussuscept through the anastomosis to the distal jejunum. To avoid repetitive intussusception, the anastomotic region was excised, and the reconstruction was performed via functional end-to-end anastomosis. Stasis improved, and the patient was discharged on the 26th day post reoperation.
Intussusception should be considered as a potential cause of intestinal obstruction around the anastomotic region.