A Case of Retrograde Intussusception after Distal Gastrectomy with Roux-en-Y Reconstruction

Abstract

A 40-year-old man with sudden abdominal pain was brought to our hospital by ambulance. He had undergone laparoscopic distal gastrectomy at an other hospital two years prior. Since strangulated ileus was suspected on abdominal CT, emergency surgery was performed. The small intestine showed intussusception due to edema and ischemic change. After manual replacement by Hutchinson's maneuver, improvement in the ischemic change and absence of any necrotic change were confirmed in the intussuscepted small intestine, and the operation was finished without resection. The findings showed that distal gastrectomy with Roux-en-Y reconstruction had been performed, and that the part of the small intestine toward the anal side of the Roux-en-Y anastomosis was retrogradely intussuscepted approximately 15 cm to the Y limb toward the ligament of Treitz. The patient's postoperative course was uneventful, and he was discharged 10 days after the surgery. Esophagogastroduodenoscopy performed after discharge showed no findings such as a tumor or polyp that might have formed the end of the intussusception on the part of the small intestine toward the anal side of the Roux-en-Y anastomosis. Although intussusception after gastrectomy is a rare complication, the possibility of intussusception occurring due to the reconstruction method used after gastrectomy has not been sufficiently analyzed.