A Case of Retrograde Intussusception at the Roex-en-Y Anastomosis after Laparoscopic Total Gastrectomy

Abstract

A 51-year-old female patient underwent a laparoscopic total gastrectomy and D2 lymphadenectomy with Roux-en-Y reconstruction for pT3N0M0 pStage II A gastric cancer. At postoperative month 13, she presented at the emergency department with an abrupt onset of abdominal pain and vomiting. An abdominal plain X-ray revealed a small amount of intestinal gas and intestinal dilatation. An abdominal computed tomography demonstrated a target sign in the jejunal limb near the Y anastomosis and dilatation of the oral side of the jejunal limb. A nasal tube was inserted for decompression and drained dark red fluid. Based on these findings, strangulated bowel obstruction with intussusception in the Y-anastomosis was diagnosed, and emergency surgery was performed on the same day. No evidence of recurrence was found intra-abdominally, and the jejunum on the anal side of the Y-anastomosis was retrogradely intussuscepted within the jejunum limb and partly within the Y-limb. As the invagination was unable to be repositioned using the Hutchinson technique, the invaginated area was resected, and the Y-anastomosis was re-reconstructed. There are few reports of similar retrograde intussusception after a total gastrectomy. Early diagnosis and early intervention should be considered for intussusception at the Y anastomosis after a gastrectomy.