Early Postoperative Retrograde Jejunojejunal Intussusception after Total Gastrectomy with Roux-en-Y Esophagojejunostomy: A Case Report
A 77-year-old woman visited Chonbuk National University Hospital because of gastric adenocarcinoma detected at a periodic examination. She had no history of abdominal surgery. Radical total gastrectomy with Roux-en-Y esophagojejunostomy was performed. After radical total gastrectomy, the jejunum was resected 20 cm below from the Treitz ligament. Distal part of resected jejunum was pulled up through the transverse mesocolon, and esophagojejunostomy was constructed in end-to-side anastomosis by using an EEA stapler (25 mm; Covidien, Mansfield, MA, USA). Fifty centimeters below the esophagojejunostomy site, a jejunojejunostomy was constructed by performing end-to-side hand-sewn anastomosis. A nasojejunal feeding tube (NJFT) was inserted into the distal part of the efferent loop of the jejunostomy for early postoperative enteral nutrition. A closed drain tube was placed at the esophagojejunostomy through the abdominal wall.\nOn the fifth postoperative day, the patient complained of abdominal pain, and bile-colored fluid was seen in the closed drain tube. A water-soluble contrast swallowing imaging study indicated leakage at the esophagojejunostomy site and dilatation of the Roux limb and the afferent loop of the jejunojejunostomy, which indicated intestinal obstruction (). Emergency surgery was performed.\nDuring surgery, retrograde jejunojejunal intussusception accompanied with NJFT was found at the efferent loop of the jejunojejunostomy. The intussusception was approximately 7 cm in length from the NJFT tip portion to the jejunojejunostomy and showed mild edematous changes without necrosis (). Manual reduction without bowel resection and primary repair of esophagojejunostomy was performed, and the NJFT was removed. Feeding Jejunostomy for enteral nutrition was constructed at the distal part of the efferent loop of the jejunojejunostomy. On the ninth repostoperativeday, a follow-up soluble contrast swallowing imaging study showed no leakage. She was discharged without complications on the 23rd re-postoperativeday.