Summary:
Retrograde jejunogastric intussusception (RJGI) after gastric
bypass surgery is a rare but potentially life threatening
complication. This complication may develop after simple
gastrojejunostomy, after lower partial resection of stomach
with gastrojejunostomy (Billroth-II gastric surgery) or after
Roux-en-Y gastric bypass. Among the three anatomic type of
jejunogastric intussusception (JGI), type-II is the commonest
variety. The acute form is a surgical emergency. Mortality rate
is very high. Little is known about the mechanism but many
literatures indicate abnormal motility may be a cause. A 50
year old male presented to us with a three month history of
repeated vomiting and one day of upper mid-abdominal pain.
He had a history of gastric bypass for pyloric stenosis 12 years
back. Diagnosis was confirmed by upper GI endoscopy. At
laparotomy type II retrograde jejunogastric intussusception
was identified. En-block resection of affected segment of
jejunum and lower part of the stomach was done followed by
Roux-en-Y reconstruction. RJGI is a rare complication of
gastric bypass surgery. Early diagnosis is imperative. High
index of suspicion is therefore important. Barium meal X-ray,
ultra sonogram, enhanced CT scan occasionally be diagnostic,
but endoscopy is certainly diagnostic in experienced hand.
Laparotomy is mandatory. Surgical options include simple
reduction, en-block resection and/or plication.
Key word – intussusception, jejunogastric, retrograde.
(J Banagladesh Coll Phys Surg 2015; 33: 161-165)