Kawano Fumiaki, Tashiro Kousei, Nakao Hironobu, Fujii Yoshirou, Ikeda Takuto, Takeno Shinsuke, Nakamura Kunihide, Nanashima Atsushi
Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan.
Faculty of Medicine, University of Miyazaki, Department of Surgery, Japan.
Int J Surg Case Rep. 2018;44:105-109. doi: 10.1016/j.ijscr.2017.12.042. Epub 2018 Jan 31.
Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment.
An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high-grade fever occurred on postoperative day 12, after which oral intake became difficult.
Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception.
Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary.
空肠胃套叠是胃部手术后一种罕见的并发症。胃部手术后的套叠大多发生在毕Ⅱ式重建的胃空肠吻合口和布朗吻合口，以及Roux-en-Y重建的Y形吻合口处。然而，Roux-en-Y重建的远端胃切除术后空肠胃套叠非常罕见。我们报告一例因胃癌治疗行远端胃切除术后发生空肠胃套叠的手术病例。
一名82岁女性因早期胃癌接受腹腔镜远端胃切除术。采用Roux-en-Y吻合进行重建。术后第4天开始经口进食，但术后第12天出现呕吐和高热，此后经口进食变得困难。
怀疑胃空肠吻合口狭窄，进行了各种检查。胃镜和计算机断层扫描显示吻合口处有一个隆起病变，有环状皱襞突入残胃。在诊断为空肠胃套叠后，于术后第28天进行了再次手术。套叠未能复位，因此对胃空肠吻合口进行了部分切除，并再次进行了Roux-en-Y重建。重建时考虑到套叠复发的情况。
远端胃切除术后空肠胃套叠是一种罕见的并发症；然而，当它发生时，早期诊断和适当的处理是必要的。
