A Case of Delayed Onset of Retrograde Intussusception at a Roux-en-Y Anastomosis after Laparoscopic Distal Gastrectomy

Abstract

The patient was a 54-year-old woman who had undergone laparoscopic distal gastrectomy and Roux-en-Y reconstruction (D1 dissection) for gastric cancer 9 years previously in another hospital. After that, she was getting to be aware of intermittent abdominal pain frequently. When she was admitted to our hospital, she had severe abdominal pain in the left lower quadrant of abdomen, without peritoneal signs. An elastic-soft mass with tenderness was felt there. A contrast enhanced abdominal CT scan showed “multiple concentric ring sign” in the small bowel near the Roux-en-Y anastomotic site. Therefore, we diagnosed the case as strangulation and performed emergency laparotomy. We found that the jejunum had retrogradely invaginated into the anastomotic site and the site dilated. We resected the expansion site after manual repositioning and reconstructed the anastomosis. She was discharged from our hospital 5 days after the operation. In post-gastrectomy patients, bowel overload is an extremely rare complication, accounting for 0.07 - 2.1% of all complications. We should be aware of this rare and ill-defined complication and try not to lose the chance of its early diagnosis and treatment.