腹腔鏡下幽門側胃切除術Roux-en-Y 再建術後に発生した 胃空腸吻合部腸重積の1 例

A 79-year-old woman underwent laparoscopic distal gastrectomy and Roux-en-Y reconstruction for gastric cancer. Gastrojejunal anastomosis was performed with the overlap method. The patient suffered vomiting on postoperative day (POD) 3. Upper gastrointestinal endoscopy performed on POD 8 showed jejunal mucosa protruding into the remnant stomach, and the patient was diagnosed with intussusception in the gastrojejunal anastomosis. Endoscopic repositioning by pushing the edge of the jejunum was unsuccessful, and thus, surgical repositioning was performed on POD 22. Intraoperative findings confirmed that the stump of the ascending jejunal limb was invaginated into the remnant stomach. The jejunal intussusception could not be repositioned by the Hutchinson technique; therefore, the ascending jejunum was resected and a new gastrojejunal anastomosis was constructed. There are few reports of intestinal invagination at the anastomosis of the jejunum after distal gastrectomy. This case suggests that immediate reoperation should be considered when such an invagination is diagnosed.