Abstract
An 83-year-old woman, who had undergone laparoscopic assisted total gastrectomy for gastric cancer 3 years and 5 months earlier, presented with the sudden onset of vomiting. An abdominal X-ray film revealed gas image in the expanded small intestine in the left upper quadrant of abdomen. An abdominal contrast-enhanced CT scan revealed a tumor with layered structure in the jejunum and remarkable expansion of an efferent loop and a jejunum proximal to the structure. From the abdominal CT findings, retrograde intussusception after total gastrectomy was suspected and an urgent operation was performed. Laparotomy revealed antiperistaltic invagination of the jejunal efferent loop into the jejunal afferent loop beyond the portion of Y anastomosis. We attempted to reduce the invagination by the Hutchinson's maneuver, but partial resection of the damaged jejunum was performed because improvement of edema and ischemia of the jejunum could not be expected.
Intussusception at a Roux-en-Y anastomosis after total gastrectomy, especially retrograde intussusception, is rare. Only 15 cases, including ours, have been reported in Japan. We herein describe our experience with a case of retrograde intussusception at a Roux-en-Y anastomosis after total gastrectomy, together with a review of the literature.
