A CASE OF INTUSSUSCEPTION OF THE GASTROJEJUNOSTOMY OCCURRED IN A PERIOPERATIVE PERIOD AFTER GASTRECTOMY

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  • 胃切除術後の周術期に発生した胃空腸吻合部腸重積の１例

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A woman in her fifties who had been pointed out an abnormal finding by gastric x-ray examination at a medical checkup underwent gastric endoscopy which detected a IIc lesion at the pyloric antrum. Early gastric cancer was diagnosed and distal gastrectomy with Roux-Y reconstruction using a stapling device was performed. The patient vomited in the night of the 4th hospital day. Abdominal x-ray examination on the next morning revealed remarkable dilatation of the remnant stomach, so that a gastric tube was placed. Fluoroscopic study performed on the 6th hospital day showed that contrast materials stayed in the remnant stomach and could not pass through the anastomosis site. Anastomosis stenosis was diagnosed and her clinical course had been observed while the gastric tube was placed, however, large quantities of discharge persisted. Another fluoroscopic study on the 12th hospital day revealed findings suggestive of intussusception at the anastomosis site. Re-operation was performed on the 14th hospital day when we saw that the stump of the jejunum had impacted into the remnant stomach. The surrounding gastric and small bowel walls hardened with inflammation and the intussusception could not be reduced entirely. Subsequently the whole anastomosis site was removed and reconstruction was made again.<BR>Intussusception after gastrectomy is rare and we present this case, together with cases reported so far in Japan.

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