Imaging Depiction of Retrograde Jejunogastric Intussusception

Abstract

Retrograde jejunogastric intussusception is an unusual long term complication of gastro-jejunostomy or Billroth-II reconstruction. Acute and chronic forms have been well recognised with the acute form being fatal without timely surgical intervention. The imaging findings are diagnostic, and an established emergency imaging protocol would be very useful for clinical decision making, as the clinical features are usually ambiguous. We present the systematic imaging description in a case of retrograde (type II) jejunogastric intussusception with strangulation following gastric bypass procedure.

Retrograde jejunogastric intussusception: a single-institution experience over two decades

“…14,16 Other factors are adhesions, long mesentery, gastric derangements, sudden increase in abdominal pressure and derangements in the stomal function and retrograde peristalsis. 2,14,15,17,18 In reported literature, the interval between JGI after gastric operation varied from 5 days to 55 years. 8,14 In our series, the duration was 5 to 25 years.…”

“…3 Plain radiograph may reveal gastric fluid level with a filling defect. 15 A homogenous soft tissue density at the left upper quadrant may represent small bowel in the stomach. 4,21 A water soluble upper GI contrast study or barium study will reveal "coiled spring" appearance and a central defect in the stomach.…”

“…4,21 A water soluble upper GI contrast study or barium study will reveal "coiled spring" appearance and a central defect in the stomach. 4,15 Upper gastrointestinal endoscopy is diagnostic and therapeutic in selected cases. 15 It is the diagnostic procedure for patient with hematemesis.…”

“…4,15 Upper gastrointestinal endoscopy is diagnostic and therapeutic in selected cases. 15 It is the diagnostic procedure for patient with hematemesis.…”

“…When there is strangulation with gangrenous bowel resection will be mandatory. 6,15,25,26 Laparoscopic examination with reduction of of the intussusception via a minilaparotomy wound. 24 To prevent recurrence few authors suggested fixation of jejunum to the adjacent tissue, mesocolon, colon, stomach or faliciform ligament.…”