RECURRENT JEJUNOJEJUNOSTOMY AND GASTROJEJUNOSTOMY INTUSSUSCEPTION COMPLICATED BY ISCHEMIC BOWEL

Sheena Say Hoon Phua¹, Bo Chuan Tan², Chun Hai Tan², Tzu-Jen Tan². ¹Khoo Teck Puat Hospital, National Healthcare Group, ²Khoo Teck Puat Hospital

INTRODUCTION: Gastrojejunostomy intussuception is a rare but serious complication of previous gastric surgery, in particular gastrojejunal bypass and Bilroth II gastrectomy. The incidence is less than 0.1%. The incidence of double intussusception with a jejunoejunostomy intusscepting into a gastrojejunostomy, is even rarer , with only 3 similar cases in literature thus far.

CASE PRESENTATION: We present the case of a 55 year old gentleman with previous gastrojejunostomy bypass due to chronic duodenal ulcer, and jejunojejunostomy subsequently for efferent loop obstruction, who was referred to us for intestinal obstruction. CT abdomen and pelvis suggest intussuception of small bowel into the stomach. He underwent an emergency laparotomy with reduction of small bowel intussuception with good recovery after. He developed abdominal pain again 2 months later and CT investigation revealed possible ischemic bowel secondary to jejunojejunostomy and gastrojejunostomy intussusception. He underwent exploratory laparotomy, distal gastrectomy with en bloc resection of gastrojejunostomy and jejunojejunostomy roux-en-y reconstruction, and recovered uneventfully post operatively. We postulate this gentleman predisposition for double intussusception could be a result of the wide gastrojejunostomy and the proximity of the gastrojejunostomy to jejunojejunostomy.

CONCLUSION: Double intussusception with jejunojejunostomy into gastrojejunostomy is an extremely rare complication of gastrectomy and gastrojejunostomy. A high index of suspicion is needed to detect it and early surgical management is required. Surgical management with reduction alone may not be sufficient and interventions such as gastropexy or reconstruction should be performed. There is however no clear guideline currently on the best definitive management as this is a rare condition that is not frequently encountered.