Case 16. Diagnosis
Section Editor: Lawrence A. Stein, MD
Canadian Journal of Surgery 1997;40(4):264.
Submitted by Lawrence A. Stein, MD, Department of Diagnostic Radiology, Royal Victoria Hospital, Montreal, Que.
Submissions to Radiology for the Surgeon should be sent to Dr. Lawrence A. Stein, c/o Dr. Jonathan L. Meakins, Rm. S10.34, Royal Victoria Hospital, 687 Pine Ave. W, Montreal, QC H3A 1A1.
© 1997 Canadian Medical Association
Jejunogastric intussusception
Jejunogastric intussusception is a potentially lethal complication of gastric surgery. This disorder has been reported sporadically since 1914.
The plain film of the abdomen (Fig. 1) shows an unusual gas shadow in the left upper quadrant with what appears to be a mass involving the gastric remnant. The nasogastric tube is also in an unusual, more vertical, position.
The barium study (Fig. 2) confirms the diagnosis. There are multiple bowel loops filling the gastric remnant, and there is complete obstruction of the gastric outlet.
Jejunogastric intussusception presents with a triad of high intestinal obstruction, a left upper quadrant mass and hematemesis. Sonography is the imaging method of first choice because the diagnosis can be made with a high degree of certainty. CT allows differentiation of the disease, and the views given by CT are often more easily accepted by surgeons.
Efferent loop intussusception is the most common; however, variations such as afferent, efferent, combined and jejunogastric intussusception occur without discernible anatomic cause. A disorder of motility rather than a technical feature is assumed to be the cause.
Bibliography
- O'Dell KB, Gordon RS, Victory C. Acute jejunogastric intussusception: a rare cause of abdominal pain. Ann Emerg Med 1992;21(5):565-7.
