A Case Report of Recurrence of Intussusception at the Anastomosis Site That Necessitated Change of the Reconstruction Method from Billroth Ⅱ to Roux-en-Y

<p>A 69-year-old man who had undergone distal gastrectomy for duodenal ulcer 40 years ago presented to the hospital with the chief complaints of sudden epigastric pain and frequent vomiting. Abdominal and pelvic contrast-enhanced computed tomography revealed invagination of the small intestine into the gastric remnant near the gastric remnant–jejunal anastomosis site, with a typical target sign. The patient was diagnosed as having intussusception of the small intestine into the gastric remnant near the anastomosis site. Emergency surgery was performed. The Billroth Ⅱ method was used for post-gastrectomy reconstruction, and the efferent loop showed retrograde invagination into the gastric remnant. As no intestinal necrosis was observed, only manual reduction was performed. Four months later, the patient returned to the hospital with a recurrence of the symptoms, and abdominal CT revealed recurrence of the intussusception. The anastomosis was separated again via open surgery, and a different procedure, the Roux-en-Y method, was used for the reconstruction. No recurrence was observed 3 years postoperatively. Cases of intussusception at the anastomosis site after gastrectomy are rare. We report a case in which a change in the reconstruction procedure was needed because of the recurrence of intussusception soon after open reduction.</p>