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Retrograde Jejunogastric Intussusception : A Single-Institution Experience Over Two Decades
Siva Gavini*
SVIMS, Tirupati, India
Background: Jejunogastric Intussusception (JGI) after gastrojejunostomy is a rare and serious complication. Only case reports and a few small case series exist in contemporary medical literature. We report our experience with this rare complication.
Methods : A retrospective analysis of patients with a diagnosis of JGI were analyzed from November 1995 to October 2015 at our institute. Patient data regarding clinical presentation, investigations, surgical procedures,outcomes and follow-up were obtained from medical records.
Results : There were 13 cases of JGI. All were males.The mean age at presentation was 54.69 years(range 46 - 62 ). All patients presented with hematemesis or coffee ground vomiting. In addition,3 patients had pain abdomen and 2 patients had malena. On abdominal examination,six patients had diffuse abdominal tenderness and palpable lump was present in 4 cases. The time duration from gastrojejunostomy was 5 to 25 years. Upper gastrointestinal endoscopy was diagnostic in 10 cases. In 3 patients, 2 were misdiagnosed as bleeding tumour and as polyp in one patient during endoscopy All patients underwent surgical management. Most commonest type was Type II ( efferent loop) seen in 10 patients. Type III ( combined type) was seen in 2 patients. One patient had Type I ( afferent loop). In 5 patients, the intussusception was reduced without the requirement of gastrostomy and the jejunal loops were fixed. In 3 patients, a gastrostomy was done to facilitate the reduction of intussusception followed by fixation of the jejunal loops. In 2 patients, the gastrojejunostomy was taken down along with resection of the gangrenous jejunum and a Roux- en- Y reconstruction was done. In 3 patients, distal gastrectomy was required as the intussusception could not be reduced and a Roux- en- Y reconstruction was done for maintaining intestinal continuity. Two patients had post-operative wound infection. On median follow-up of 6 years, there were no recurrences. There was no mortality.
Conclusion: JGI is a rare complication after gastrojejunostomy. Upper gastrointestinal endoscopy is the most accurate diagnostic technique when performed by a experienced endoscopist. Ultrasound abdomen and contrast enhanced computed tomography of abdomen can be of additional help. Emergency surgery, still remains the main stay of treatment. A high index of suspicion is required for diagnosis in patients with prior history of gastrojejunostomy.
 Resected specimen showing jejunogastric intussusception with gangrenous jejunal loop
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