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Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 493-495
Retrograde Jejunogastric Intussusception


Department of Radiology, S.S.G. Hospital, Baroda, India

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   Abstract 

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. The imaging findings are diagnostic, in which contrast studies and CT findings are very helpful. Endoscopy performed by someone familiar with this rare entity is certainly diagnostic. There is no medical treatment for Jejunogastric intussusception and surgical intervention is required for the definite treatment. [1] In our case, 42yrs old male patient, who was known case of Sickle cell disease and with the past history of Gastrojejunostomy done 14yrs back for a chronic bleeding duodenal ulcer, presented with vomiting and vague abdominal pain.

Keywords: Intussusception, gastrectomy, JGI

How to cite this article:
Vohra P, Arora A, Parikh N, Vaghani M, Vaghela P, Vaidya V, Raniga S. Retrograde Jejunogastric Intussusception. Indian J Radiol Imaging 2005;15:493-5

How to cite this URL:
Vohra P, Arora A, Parikh N, Vaghani M, Vaghela P, Vaidya V, Raniga S. Retrograde Jejunogastric Intussusception. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Sep 24];15:493-5. Available from: http://www.ijri.org/text.asp?2005/15/4/493/29171
Here we are presenting a case of jejunogastric intussusception ( JGI ) in a 42 years old male, who is a known case of sickle cell disease and had a past history of Gastrojejunostomy done 14 years back for a chronic bleeding duodenal ulcer. He presented to us with two episodes of vomiting and a vague abdominal pain. First, the patient was taken for ultrasonographic examination, which showed distended stomach with jejunal loops within. The jejunal loops were identified on the basis of presence of the valvulae conniventis seen within.

At Computed Tomography, the classical target appearance of the retrograde jejunogastric intussusception was seen with the mesenteric vessels being pulled along with the intussusception. There was presence of jejunal loops within the stomach. The imaging findings were diagnostic of the type II variety of the JGI, in which the efferent loop of the gastrojejunostomy site is involved. On contrast enhanced CT examination, the spleen showed multiple non-enhancing low density areas, suggestive of multiple splenic infarcts. (as the patient was a known case of sickle cell disease.)

On Gastrograffin examination, the stomach was distended with the contrast and showed filling defect due to the contrast outlining the intussuscepted jejunal loops. There was no mucosal irregularity or luminal narrowing seen at the stoma site. The duodenal C loop was properly delineated. The contrast was seen to pass into the distal jejunal loops.

Jejunogastric Intussusception (JGI) seems to be a rare complication after gastrojejunostomy or Billroth II gastrectomy; it also has been described rarely in association with previously placed gastrostomy tubes.

The condition was first described in 1914 by Bozzi [2] in a patient with gastrojejunostomy. A large number of isolated cases and small series have been published and the reviews of the literature showed that less than 200 cases have been reported.

Three anatomic types of JGI have been described: [3] type I concerns the afferent loop, type II the efferent loop and type III represents a combined form. It has been stated that type II or retrograde efferent loop intussusception is the most common (80%) with the two other types accounting for 10% each. In our case type II of JGI was noticed.

There is a wide variation in the lapse time between the gastric operation and the JGI to occur: 6 days to 20 years and 8 days to 19 years in patients with gastrojejunostomy and partial gastrectomy respectively. In our case the lapse time was of 14yrs after the gastrojejunostomy. Two forms of JGI have been clinically recognized: an acute and a chronic form. In the acute form, incarceration and strangulation of the intussuscepted loop generally occur whilst spontaneous reduction is usual in the chronic type. It should be pointed out that a sudden onset of epigastric pain, vomiting and subsequent hematemesis, and a palpable epigastric mass in a patient with a previous gastric surgery are thought as the classic triad of JGI [4]. In the chronic form, the symptoms may be roughly similar to the acute form but milder, transient and subside spontaneously [5]. In our case there was spontaneous reduction of the intussusception, when endoscopy was employed after the CT scan of the patient, and the patient had presented with 2 episodes of vomiting and vague epigastric abdominal pain, thus giving a typical picture of a chronic variety of JGI.

Thus, in a chronic form, for the correct diagnosis to be made, upper GI imaging should be performed during the symptomatic period. It is clear that there is no medical treatment for JGI and the correct treatment is the surgical intervention as soon as possible. Surgical options include reduction, resection, and revision of the anastomosis, depending on the conditions found during the operation [6]. The best way to prevent recurrence, if any, has not been identified yet [6],[7].

 
   References Top

1.Athanasios J. Archimandritis, Nikos Hatzopoulos, Petros Hatzinikolaou et.al. Jejunogastric intussusception presented with hematemesis: a case presentation and review of the literature. BMC Gastroenterol. 2001; 1 (1): 1  Back to cited text no. 1    
2.Bozzi, E: Annotation. Bull Acad Med 1914, 122:3 4.  Back to cited text no. 2    
3.Shackman, R: Jejunogastric intussusception. Br J Surg 1940, 27:475 480  Back to cited text no. 3    
4.Foster, DG: Retrograde jejunogastric intussusception-a rare cause of hematemesis. AMA Arch Surg 1956, 73:1009 1017  Back to cited text no. 4    
5.Olsen, AK & Bo, O: Intussusception as a complication of partial gastrectomy-a case report. Acta Chir Scand 1978, 144:405 408.  Back to cited text no. 5    
6.Waits, JO, Beart, RW, Jr, & Charboneau, JW: Jejunogastric intussusception. Arch Surg 1980, 115:1449 1452.  Back to cited text no. 6    
7.Czeriak, A, Bass, A, Bat, L, Shemesh, E, Avigad, I, & Wolfstein, I: Jejunogastric intussusception-a new diagnostic test. Arch Surg 1987, 122:1190 1192.  Back to cited text no. 7    

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Correspondence Address:
A Arora
601-602, Highland Building No.5, Behind Anita Nagar, Lokhandwala Complex, Kandivli- East , Mumbai - 400101
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29171

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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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