Common Jejunal Tract Intussusception into the Jejuno-Jejunal Anastomosis as Long-Term Complication after near Total Gastrectomy for Distal Gastric Cancer
Corresponding AuthorMassimiliano Fabozzi
Unit of General and Oncological Surgery ( Chief: M.FABOZZI,MD,PhD), “A. Tortora” Pagani Hospital, Italy
A B S T R A C T
Background: Intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB) and extremely rare after near total gastrectomy. Case Presentation: 46-years-old woman (BMI=40 kg/m2 , co-morbidity: hypertension) operated about seven months before of near total gastrectomy (for distal gastric cancer) with a small bowel resection with Roux and Y gastric reconstruction , presented epigastric pain after meals, alvus alterations lasting by a week, vomiting in the last days with leukocytosis and transaminase and amylase increase. The CT scan showed peri-hepatic fluid, gastric, duodenal and jejunal dilatation, a "target like imagine" of jejuno-jejunal anastomosis with small bowel air-fluid levels, normal intestinal loop downstream the jejuno-jejunal anastomosis. During laparoscopy we discovered ischemia of common jejunal tract intussuscepted into the jejuno-jejunal anastomosis. The common ischemic intestinal tract and the anastomosis were resected “enbloc” and jejuno-jejunal anastomosis was performed again. Conclusion: The symptoms of small bowel intussusception after near total gastrectomy are not specifics but the risk of severe complications requires an early diagnosis and treatment. According to literature data, CT-scan is the gold standard for the diagnosis but in unclear cases it is mandatory an early laparoscopic exploration to confirm the clinical suspicion and to perform the appropriate treatment.
Article TypeCase Report
Publication historyReceived: Thu 19, Dec 2019
Accepted: Fri 27, Dec 2019
Published: Mon 20, Jan 2020
Copyright© 2019 Massimiliano Fabozzi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository. All rights reserved.