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Jejunogastric intussusception presenting as tumor bleed.

Rather SA, Dar TI, Wani RA, Khan A - J Emerg Trauma Shock (2010)

Bottom Line: Jejunogastric intussusception (JGI) is a rare but serious complication of previous gastrectomy or gastrojejunostomy, and a delayed diagnosis can lead to catastrophe.We present a case of JGI presenting as hematemesis and diagnosed as tumor bleed on endoscopy.Diagnosis of JGI was confirmed on laparotomy, gangrenous efferent limb was resected and a fresh gastrojejunostomy performed.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir - 190 011, India.

ABSTRACT
Jejunogastric intussusception (JGI) is a rare but serious complication of previous gastrectomy or gastrojejunostomy, and a delayed diagnosis can lead to catastrophe. It can present as hematemesis, and an endoscopist aware of the condition can diagnose it early. We present a case of JGI presenting as hematemesis and diagnosed as tumor bleed on endoscopy. Diagnosis of JGI was confirmed on laparotomy, gangrenous efferent limb was resected and a fresh gastrojejunostomy performed.

No MeSH data available.


Related in: MedlinePlus

Intussuscepting the efferent jejunal limb into the stomach before gastrotomy incision is made
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Figure 0001: Intussuscepting the efferent jejunal limb into the stomach before gastrotomy incision is made

Mentions: A 65-year-old male patient presented to our emergency department with epigastric pain and vomiting for 2 days and hematemesis for 1 day. He had vomited almost 1.5–2 l of blood over the last 24 hours (the vomited blood was preserved by the attendants in a bowl) before presentation. There was history of diarrhea with melina, a sample of which was presented by the attendants in casualty. Previous records revealed that a retro colic gastrojejunostomy with truncal vagotomy was performed 15 years back for peptic ulcer disease. On examination, the patient was pale with a pulse rate of 96 beats per minute (bpm) and blood pressure (BP) of 100/60. A tender, firm epigastric mass was palpable. Laboratory investigations revealed a hemoglobin (HB) of 7.8 g/dl, total leukocyte count (TLC) of 15,000 with 90% neutrophills. Coagulogram, platelet count and serum creatinine were normal. Two large bore intravenous access lines were established, nasogastric tube inserted, and the patient was catheterized. The patient was being resuscitated by crystalloids and blood transfusions to gain time for upper gastrointestinal (GI) endoscopy. X-ray abdomen was done during the process of resuscitation, which was grossly normal. USG abdomen revealed stomach full of echogenic material (blood). After stabilization, the patient was taken for upper GI endoscopy which revealed findings suggestive of a bleeding gastric tumor with stomach full of clots. The bleeding was not controlled by endoscopic measures, and the patient was taken for emergency laparotomy. On laparotomy, efferent limb of jejunum was intussuscepting into the stomach [Figure 1]. Gastrotomy was performed along the greater curvature on the anterior surface of the stomach. The pooled blood and clots were wiped out and the intussuscepted gangrenous efferent jejunal limb was revealed as a mass [Figure 2]. About 25 cm of the gangrenous intussuscepted efferent limb of jejunum [Figure 3] was resected from the stomach, and its stump was closed flush with stomach wall after everting it. Ryle’s tube was passed through antrum, duodenum and back into the stomach through the previous gastrojejunostomy to identify the afferent limb. A fresh anti colic, side to side gastrojejunostomy was performed along the greater curve using the gastrotomy incision. The postoperative period was uneventful and the patient was discharged on 7th postoperative day. Histopathologic examination of the resected bowel showed features of necrosis. He is on our regular follow up and is asymptomatic since the last 6 months.


Jejunogastric intussusception presenting as tumor bleed.

Rather SA, Dar TI, Wani RA, Khan A - J Emerg Trauma Shock (2010)

Intussuscepting the efferent jejunal limb into the stomach before gastrotomy incision is made
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966578&req=5

Figure 0001: Intussuscepting the efferent jejunal limb into the stomach before gastrotomy incision is made
Mentions: A 65-year-old male patient presented to our emergency department with epigastric pain and vomiting for 2 days and hematemesis for 1 day. He had vomited almost 1.5–2 l of blood over the last 24 hours (the vomited blood was preserved by the attendants in a bowl) before presentation. There was history of diarrhea with melina, a sample of which was presented by the attendants in casualty. Previous records revealed that a retro colic gastrojejunostomy with truncal vagotomy was performed 15 years back for peptic ulcer disease. On examination, the patient was pale with a pulse rate of 96 beats per minute (bpm) and blood pressure (BP) of 100/60. A tender, firm epigastric mass was palpable. Laboratory investigations revealed a hemoglobin (HB) of 7.8 g/dl, total leukocyte count (TLC) of 15,000 with 90% neutrophills. Coagulogram, platelet count and serum creatinine were normal. Two large bore intravenous access lines were established, nasogastric tube inserted, and the patient was catheterized. The patient was being resuscitated by crystalloids and blood transfusions to gain time for upper gastrointestinal (GI) endoscopy. X-ray abdomen was done during the process of resuscitation, which was grossly normal. USG abdomen revealed stomach full of echogenic material (blood). After stabilization, the patient was taken for upper GI endoscopy which revealed findings suggestive of a bleeding gastric tumor with stomach full of clots. The bleeding was not controlled by endoscopic measures, and the patient was taken for emergency laparotomy. On laparotomy, efferent limb of jejunum was intussuscepting into the stomach [Figure 1]. Gastrotomy was performed along the greater curvature on the anterior surface of the stomach. The pooled blood and clots were wiped out and the intussuscepted gangrenous efferent jejunal limb was revealed as a mass [Figure 2]. About 25 cm of the gangrenous intussuscepted efferent limb of jejunum [Figure 3] was resected from the stomach, and its stump was closed flush with stomach wall after everting it. Ryle’s tube was passed through antrum, duodenum and back into the stomach through the previous gastrojejunostomy to identify the afferent limb. A fresh anti colic, side to side gastrojejunostomy was performed along the greater curve using the gastrotomy incision. The postoperative period was uneventful and the patient was discharged on 7th postoperative day. Histopathologic examination of the resected bowel showed features of necrosis. He is on our regular follow up and is asymptomatic since the last 6 months.

Bottom Line: Jejunogastric intussusception (JGI) is a rare but serious complication of previous gastrectomy or gastrojejunostomy, and a delayed diagnosis can lead to catastrophe.We present a case of JGI presenting as hematemesis and diagnosed as tumor bleed on endoscopy.Diagnosis of JGI was confirmed on laparotomy, gangrenous efferent limb was resected and a fresh gastrojejunostomy performed.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir - 190 011, India.

ABSTRACT
Jejunogastric intussusception (JGI) is a rare but serious complication of previous gastrectomy or gastrojejunostomy, and a delayed diagnosis can lead to catastrophe. It can present as hematemesis, and an endoscopist aware of the condition can diagnose it early. We present a case of JGI presenting as hematemesis and diagnosed as tumor bleed on endoscopy. Diagnosis of JGI was confirmed on laparotomy, gangrenous efferent limb was resected and a fresh gastrojejunostomy performed.

No MeSH data available.


Related in: MedlinePlus