A Case of Recurrent Post-gastrectomy Jejunal Intussusception Treated with Jejunal Abdominal Wall Fixation

Abstract

A 76-year-old man, who had undergone distal gastrectomy with Billroth-II reconstruction and Braun anastomosis for gastric ulcer at the age of 23, presented to our hospital because of abdominal pain. Emergency laparotomy performed with the diagnosis of intussusception revealed retrograde intussusception of the jejunum where was distal from the Braun anastomosis. After the intussusception was manually reduced, we confirmed that there were no ischemic findings nor organic diseases such as a tumor in the bowel and terminated the operation. Two years later, he developed intussusception again and underwent emergency operation. Intraoperative findings revealed the same retrograde intussusception as the former operation had demonstrated. Observation of the bowel after manual reduction showed absence of apparent ischemic findings on the bowel and the bowel had developed apparent reverse peristalsis. In order to prevent the recurrence, a reduced segment of jejunum telescoping into the adjacent segment was fixed to the abdominal wall. Thereafter no recurrence has occurred. In a review of the literature, we encountered some cases of post-gastrectomy intussusception, in which mechanical factors such as something wrong in the pacemaker might contribute to jejunal intussusception. Consequently, in the treatment of post-gastrectomy intussusception, we should consider not only simple reduction of intussusception but also additional application of procedure according to factors causing intussusception to prevent recurrence.