Abstract
A 78-year-old woman underwent distal gastrectomy with Roux-en-Y reconstruction for gastric cancer. The patient resumed oral intake on the 4th postoperative day ; however, vomiting developed on the 12th postoperative day, making continued oral intake difficult. A fluoroscopic study performed on the 15th postoperative day showed retained contrast material in the remnant stomach, as it failed to pass through the anastomosis site. Upper gastrointestinal endoscopy performed on the 16th postoperative day showed a mass lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Based on the findings, the patient was diagnosed as having jejunogastric intussusception. The endoscope could pass through the anastomosis site, so that a gastric tube was placed. A repeat fluoroscopic study on the 22nd postoperative day showed failure of reduction of the intussusception. Reoperation was performed on the 25th postoperative day. The surrounding gastric and small bowel walls were hardened with inflammation and the intussusception could not be completely reduced. Therefore, we made an incision in the anterior wall of the remnant stomach and terminated the intussusception with linear staplers.
Jejunogastric intussusception after Roux-en-Y reconstruction is a rare complication, and only three cases have been reported so far. In all the reported cases, the anastomosis site was resected and another Roux-en-Y anastomosis was created, but we were able to preserve the anastomosis site.
