Yeungnam Univ J Med.  2020 Jul;37(3):236-241. 10.12701/yujm.2020.00038.

Jejunogastric intussusception prone to misdiagnosis as gastric cancer

• Park YE
• Kim SW

• KMID: 2506524
• DOI: http://doi.org/10.12701/yujm.2020.00038

Abstract

The authors report a case of a 78-year-old female with a history of gastric surgery 35 years ago. She was initially misdiagnosed as gastric cancer bleeding and underwent an emergency laparotomy under the diagnosis of jejunogastric intussusception (JGI), 23 hours after the onset of symptoms. We also reviewed 116 JGI case reports and analyzed clinical features and outcomes. Compared to the past, diagnosis of JGI is easier with diagnostic examinations such as an endoscopy, computed tomography, and the upper gastrointestinal series. And a good prognosis can be expected with proper fluid resuscitation and surgical reduction, even if the symptoms persist more than 48 hours.

Keyword

Gastroenterostomy; Intussusception; Jejunogastric intussusception

Figure

• 

  Fig. 1. Computed tomography findings of the jejunogastric intussusception patient. Both coronal (A) and axial view (B) show the intussuscepted jejunal loop (arrow) with the entrapped mesenteric vessel and fat (arrowhead) in the dilated stomach.

• 

  Fig. 2. Endoscopic findings of jejunogastric intussusception patient. (A) A bulky and congestive mass is seen (B) edematous mucosal fold (arrow) and the lumen (arrowhead) of intussuscepted jejunum is seen.

• 

  Fig. 3. Numbers of well recovered (A) and died (B) jejunogastric intussusception cases are demonstrated by published year.

Reference

References

1. Lee SH, Kwon IG, Ryu SW, Sohn SS. Jejunogastric intussusception: a rare complication of gastric cancer surgery. Int J Clin Exp Med. 2014; 7:4498–502.

2. WISOFF CP. Jejunogastric intussusception. Radiology. 1953; 61:363–7.

3. Kawano F, Tashiro K, Nakao H, Fujii Y, Ikeda T, Takeno S, et al. Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: a case report. Int J Surg Case Rep. 2018; 44:105–9.

4. Tokue H, Tsushima Y, Arai Y, Endo K. Jejunogastric intussusception: life-threatening complication occuring 55 years after gastrojejunostomy. Intern Med. 2009; 48:1657–60.

5. Shackman R. Jejunogastric intussusception. Br J Surg. 1940; 27:475–80.

6. Brynitz S, Rubinstein E. Hematemesis caused by jejunogastric intussusception. Endoscopy. 1986; 18:162–4.

7. Kitasato Y, Midorikawa R, Uchino Y, Saku S, Minami T, Shirahama T, et al. A case of retrograde intussusception at Roux-en-Y anastomosis 10 years after total gastrectomy: review of the literature. Surg Case Rep. 2016; 2:123.

8. Hocking MP, McCoy DM, Vogel SB, Kaude JV, Sninsky CA. Antiperistaltic and isoperistaltic intussusception associated with abnormal motility after Roux-en-Y gastric bypass: a case report. Surgery. 1991; 110:109–12.

9. Bundrick TJ, Turner MA. Retrograde jejunogastric intussusception. Rev Interam Radiol. 1981; 6:21–4.

10. Sachdev BS, Malhotra P, Sukanya B, Prasad L, Kapoor D. Post gastro-jejunostomy acute retrograde jejuno-gastric intussusception. Trop Gastroenterol. 2010; 31:329–32.

11. Reyelt WP Jr, Anderson AA. retrograde jejunogastric intussusception. Surg Gynecol Obstet. 1964; 119:1305–11.

12. Czerniak A, Bass A, Bat L, Shemesh E, Avigad I, Wolfstein I. Jejunogastric intussusception. A new diagnostic test. Arch Surg. 1987; 122:1190–2.

13. Hashimoto Y, Akagi S, Sakashita Y, Takamura M, Iwako H, Watadani Y, et al. Usefulness of computed tomography as a preoperative diagnostic modality in a case with acute jejunogastric intussusception. J Gastrointest Surg. 2007; 11:1078–80.

14. Singh S, Singh A, Bhagat S, Singh B. Retrograde Jejuno-gastric Intussusception. Niger J Surg. 2015; 21:70–2.

15. Rather SA, Dar TI, Wani RA, Khan A. Jejunogastric intussusception presenting as tumor bleed. J Emerg Trauma Shock. 2010; 3:406–8.

16. Toth E, Arvidsson S, Thorlacius H. Endoscopic reduction of a jejunogastric intussusception. Endoscopy. 2011; 43(Suppl 2 UCTN):E63.

17. Guadagni S, Pistoia M, Catarci M, Carboni F, Lombardi L, Carboni M. Retrograde jejunogastric intussusception: is endoscopic or surgical management more appropriate? Surg Today. 1992; 22:269–72.

18. Walstad PM, Ritter JA, Arroz V. Delayed jejunogastric intussusception after gastric surgery: an ever-present threat. Am Surg. 1972; 38:172–5.