Jejunogastric Intussusception after Pylorus Resecting Pancreaticoduodenectomy: A Rare Case Report and Review of the Literature

TL;DR

A rare case of jejunogastric intussusception after pancreatic surgery is reported, emphasizing the need for prompt diagnosis and treatment to avoid severe complications.

Contribution

This case report adds to the limited literature on jejunogastric intussusception following pancreaticoduodenectomy and highlights successful non-resection management.

Findings

Jejunogastric intussusception was successfully treated using manual reduction without resection.

Indocyanine green fluorescence imaging confirmed adequate intestinal blood flow during surgery.

The patient had an uneventful recovery with no recurrence after one year.

Abstract

Jejunogastric intussusception is a rare complication that can occur following gastrectomy or gastric bypass surgery. The occurrence of intestinal intussusception after pancreaticoduodenectomy (Child reconstruction) has been reported in very few cases in the literature.

Here, we present the case of a 75-year-old patient who developed jejunogastric intussusception following pancreaticoduodenectomy performed for intraductal papillary mucinous neoplasm of the pancreatic head. The diagnosis was confirmed by contrast-enhanced abdominal CT and upper gastrointestinal endoscopy. During the operation, the efferent limb was intussuscepted into the gastric lumen. Manual Hutchinson’s maneuver of the intussusception was successfully performed without incision of the stomach or jejunum. Intestinal blood flow was assessed during surgery using indocyanine green fluorescence imaging and adequate blood flow was confirmed. The surgery was completed without intestinal resection or incision of the stomach or jejunum. The patient’s postoperative course was uneventful, and he was discharged in stable condition on POD 11. He showed no recurrence at follow-up 1 year after the surgery.

Although jejunogastric intussusception is an uncommon complication following pancreaticoduodenectomy, it can lead to life-threatening outcomes. Delayed diagnosis can necessitate bowel resection. Prompt diagnosis and emergent surgical intervention are essential for effective treatment, highlighting the importance of a rapid clinical response from diagnosis to treatment regarding jejunogastric intussusception.

Figures