Intussusception of the small intestine loop into the gastric lumen through gastroenteroanastomosis after pancreaticoduodenectomy: A clinical case

Background. Intussusception of the small intestine loop through gastroenteroanastomosis is considered a rare but potentially dangerous complication that can occur after gastroenteroanastomosis surgery. This complication is extremely seldom associated with pancreaticoduodenectomy.

Case description. A 44-year male patient underwent pancreaticoduodenectomy for common bile duct cancer on 07.10.2019, followed by adjuvant chemotherapy. On April 14, 2021 he was admitted for the next course of chemotherapy and complained of pain in the epigastric region and nausea, that appeared a few days ago, thus, he was appointed an urgent additional examination. Gastroscopy revealed a loop of small intestine, prolapsing into the lumen of the gastric remnant through the gastroenteroanastomosis. The fixed loop of intestine precluded endoscopic disinvagination from being performed. Computed tomography confirmed intussusception of the small intestine loop through gastroenteroanastomosis. The patient underwent emergency surgery. Laparotomy revealed a 40 cm intussusception of the small intestine loop through gastroenteroanastomosis into the gastric remnant. The intestine loop was accurately disinvaginated and proved to be viable. The intestine loop was additionally fixed to prevent re-intussusception. After the complication-free postoperative period, the patient was discharged on day 6. The follow-up examination in 6 months revealed no signs of intussusception recurrence according to computed tomography. The paper reviewed the internationally published cases of jejunogastric intussusception after pancreaticoduodenectomys.

Conclusion. Jejunogastric intussusception refers to an extremely rare complication after a previously performed pancreaticoduodenectomy. A risk of the complications is to be recognized, since their timely diagnosis and surgical treatment enable successful outcome to be achieved.

1. González-Carreró Sixto C, Baleato-González S, García Palacios JD, Sánchez Bernal S, Junquera Olay S, Bravo González M, García Figueiras R. Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management. Radiologia (Engl Ed). 2023;65(3):213–221. https://doi.org/10.1016/j.rxeng.2022.10.005

2. Abu-Omar N, Spafford M, Seshadri P. A rare case of jejunogastric intussusception: A case report and review of the literature. Int J Surg Case Rep. 2021;82:105862. https://doi.org/10.1016/j.ijscr.2021.105862

3. Miah AG, Imam NA, Joarder RH, Talukder SI, Hossain MS. Retrograde jejunogastric intussusception (JGI) with strangulation following previous gastrojejunostomy. Mymensingh Med J. 2006;15(1):99–101. https://doi.org/10.3329/mmj.v15i1.5

4. Makni A, Rhaiem R, Maghrebi H, Haddad A, Ben Safta Z. Jejunogastric intussusception: shall we think about it? ANZ J Surg. 2019;89(6):770–772. https://doi.org/10.1111/ans.14289

5. Lazenby C, Nielson JA, Perry RS. A Case Report on Gastric Remnant Intussusception. Cureus. 2022;14(1):e21320. https://doi.org/10.7759/cureus.21320

6. Kitasato Y, Midorikawa R, Uchino Y, Saku S, Minami T, Shirahama T, Kiyomatsu K, Okuda K, Akagi Y, Tanaka H. A case of retrograde intussusception at Roux-en-Y anastomosis 10 years after total gastrectomy: review of the literature. SurgCaseRep. 2016;2(1):123. https://doi.org/10.1186/s40792-016-0250-6

7. Balitsky GV, Legostaev VM, Zema TV. Invagination of the Adductor Loop of the Small Intestine into the Lumen of the Gastric Stump after Pancreatoduodenal Resection. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(5):49–52 (In Russ.). https://doi.org/10.22416/1382-4376-2019-29-5-49-52

8. Patel K, Luthra A, Aberra F, Lara LF, Gray D 2nd. Intussusception After Pancreaticoduodenectomy. ACG Case Rep J. 2019;6(5):e00060. https://doi.org/10.14309/crj.0000000000000060

9. Pokataev IA, Gladkov OA, Zagainov VE, Kudashkin NE, Kuchin DM, Lyadov VK, Podluzhny DV, Tryakin AA, Fedyanin MYu., Chernykh MV. Practical recommendations for drug treatment of pancreatic cancer. Malignant Tumours. 2022;12(3s2-1):530–544 (In Russ.). https://doi.org/10.18027/2224-5057-2022-12-3s2-530-544

10. Lyu YX, Xu YM. Jejunogastric intussusception after Whipple procedure with B-II reconstruction: a case report. BMC Gastroenterol. 2020;20(1):101. https://doi.org/10.1186/s12876-020-01259-2

11. Zhou JJ, Chen WH, Zou H, Xiong L, Miao XY, He C, Shu B, Zhou YQ, Liu DL, Wen Y. Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report. J Gastrointest Oncol. 2020;11(4):820–825. https://doi.org/10.21037/jgo-20-207

12. Moore TA, Al-Habbal Y, Choi JM. Retrograde jejunogastric intussusception presenting as haematemesis in a patient following pancreaticoduodenectomy. BMJ Case Rep. 2020;13(3):e233851. https://doi.org/10.1136/bcr-2019-233851

13. Yogo K, Sando M, Kobayashi R, Yano G, Ohara N, Kawai K, Takagi K, Kawai S, Kamiya S. Jejunogastric intussusception after pancreaticoduodenectomy: a case report. Surg Case Rep. 2022;8(1):91. https://doi.org/10.1186/s40792-022-01424-7

14. Khuong JN, Lim CSH, Samra JS. Retrograde Jejunogastric Intussusception of Efferent Limb Post-Whipple Procedure. J Gastrointest Surg. 2023;27(2):449–451. https://doi.org/10.1007/s11605-022-05488-6

15. Zhang HH, Tan XZ. Cinematic Rendering of Retrograde Jejunogastric Intussusception. Radiology. 2023;309(1):e231108. https://doi.org/10.1148/radiol.231108

16. Song GJ, Yun JH, Jung HI, Son MW, Lee MS. Jejunogastric intussusception after totally laparoscopic distal gastrectomy for gastric cancer: a rare case report and review of the literature. Korean J Clin Oncol. 2022;18(1):56–59. https://doi.org/1010.14216/kjco.22007

17. Xia F, Sun Z, Wu JH, Zou Y. Intussusception after reconstruction following gastrectomy for gastric cancer. World J Surg Oncol. 2021;19(1):340. https://doi.org/10.1186/s12957-021-02456-3

18. Toth E, Arvidsson S, Thorlacius H. Endoscopic reduction of a jejunogastric intussusception. Endoscopy. 2011;43 Suppl 2 UCTN:E63. https://doi.org/10.1055/s-0030-1256103