Laparoscopic Management of Retrograde Jejuno-Gastric Intussusception: a Case Report
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CASE REPORT
Laparoscopic Management of Retrograde Jejuno-Gastric Intussusception: a Case Report Salil Kumar Parida 1 & SriVignesh Manohar 2 Received: 1 July 2020 / Accepted: 15 August 2020 # Association of Surgeons of India 2020
Abstract Jejuno-gastric intussusception is a rare but lethal complication of gastric surgeries with a reported incidence of 0.15%. A high index of suspicion is required to diagnose this condition in a patient with a history of gastric surgery. With advances in minimal access surgery, reduction of the intussusceptum is possible through laparoscopy or endoscopy. We present an elderly male who had undergone a Billroth II procedure before 27 years. The patient was diagnosed with jejuno-gastric intussusception based on ultrasound and endoscopic findings. The patient was successfully managed under laparoscopy. Keywords Intussusception . Jejuno-gastric . Laparoscopy . Gastric surgery . Efferent loop
Introduction Jejuno-gastric intussusception is a very rare complication following any gastric surgeries, most commonly following Billroth II. The first case of jejuno-gastric intussusception was reported by Bozzi in 1914 following prior gastroenterostomy done 35 years back [1]. Jejuno-gastric intussusception has a wide lapse time with cases presenting in the early postoperative period 6 days until 20 years following primary surgery [2]. Patients can present either with acute or chronic symptoms. Chronic jejuno-gastric intussusception was classified according to Shackman as follows: & & &
Type I—Antegrade or afferent loop syndrome Type II—Retrograde or efferent loop syndrome Type III—Combined form.
* SriVignesh Manohar Salil Kumar Parida [email protected] 1
Department of Surgical Gastroenterology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
2
Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
Type II or efferent loop syndrome is the most common, reported as 74% [3]. We present an elderly male with retrograde jejuno-gastric intussusception who was managed successfully by laparoscopic intervention at Mahatma Gandhi Medical College and Research Institute, Puducherry.
Case Report A 65-year gentleman was brought to the ER with upper abdominal pain and bilious vomiting for 1 day. The patient also had a previous history of surgery for peptic ulcer disease 27 years ago. On examination, a tender mass was palpable in the epigastric region. There was no visible peristalsis and the rest of the abdomen was soft. Bowel sounds were absent on auscultation and perrectal examination was normal. Differential diagnosis: a. Stump carcinoma b. Stomal ulcer/stenosis c. Intussusception The diagnosis of jejuno-gastric intussusception was confirmed by ultrasound and upper GI endoscopy. Ultrasound of the abdomen revealed the classical donut sign of intussusception, a 10-cm loop of jejunum telescoping into the stomach (Fig. 1). Upper GI
Indian J Surg Fig. 1 a, b Ultrasound abdomen showing intussusception of the jejunal loop into the
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