Jejunogastric intussusception presented with hematemesis: a case presentation and review of the literature

Abstract

Background: Jejunogastric intussusception (JGI) is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory.

Imaging Depiction of Retrograde Jejunogastric Intussusception

“…The widely accepted anatomical classification, proposed by Shackman in 1940, distinguishes three categories of jejunogastric intussusception: type I, afferent loop intussusceptions (antegrade): type II, efferent loop intussusception (retrograde); and type III, mixed type. Type II is the most common (80 %) with two other types accounting for 10 % [9]. In the case presented, type II jejunogastric intussusception was documented.…”

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

“…Epigastric tenderness and a palpable abdominal mass and signs of high intestinal obstruction are additional findings on examination. 2,20 In our series, all patients presented with haemetemesis or coffeeground vomiting. Epigastric pain was present in 6/13 patients and a palpable lump in 4/13 patients.…”

“…1 Literature review showed that just over 200 cases have been reported, most of them being case reports and small series. [2][3][4][5] The reported incidence is less than 0.1% to 0.15%. 7,8 Retrograde intussusception was also reported in patients after Billroth-I reconstruction, Billroth-II reconstruction, previously placed gastrostomy tubes, pancreaticojejunostomy and total gastrectomy with Roux-en-y-anastomosis.…”

“…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.…”

“…Provocation of JGI during endoscopy by the use of jet of water directed towards the anastamotic stoma may be diagnostic of the chronic form. 2 Endoscopic reduction of JGI is contraindicated when peritoneal signs are suspected. Endoscopic reduction is associated with recurrence.…”