Anterograde jejunojejunal intussusception following Billroth II subtotal gastrectomy
70 year old male presented with abdominal pain and persistent bilious vomiting one month following Billroth II subtotal gastrectomy for gastric cancer. Ultrasound showed evidence of intussusception which was reported as ileocolic. Computed Tomography was carried out using intravenous contrast. Images were obtained in the portal venous phase. Axial CT images with multiplanar reformation revealed the site of gastrojejunostomy with grossly dilated residual stomach, afferent and efferent jejunal loops. The efferent loop was seen telescoping into the distal jejunal loop suggestive of an anterograde jejunojejunal intussusception as the cause of obstruction. The intussusceptum was markedly narrowed. Findings were confirmed peroperatively. The intussusception was reduced manually. The gut was viable and no resection was required. Dense adhesions were seen at the site of intussusception which might have served as an extraluminal lead point. To our knowledge this is the second documented case of anterograde jejunojejunal intussusception following Billroth II subtotal gastrectomy leading to efferent loop obstruction one month following surgery. In the earlier reported case this complication occurred in the immediate postoperative period.