PMC5573784_01
Abdominal computed tomography findings of antegrade gastrojejunal intussusception and choledocholithiasis.. A: A non-homogeneous mass (arrow) in the left-upper quadrant is shown. The staple line of the Roux limb stump was recognizable as a high-intensity line in the center of the mass; B: Calculi in the common bile duct are shown (arrow).
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Abdominal computed tomography scanning revealed an invaginated Roux limb of the gastrojejunostomy and calculi in the CBD, which prompted a diagnosis of antegrade jejunogastric intussusception and CBD stones (Fig. 1).
Endoscopic and contrast radiographic findings of jejunogastric intussusception.. A: Direct view of gastrofibroscopic examination demonstrating an invaginated bowel; B: Contrast radiograph shows a Roux limb invaginated in the direction of the Roux-en-Y anastomosis.
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The invaginated Roux limb of the gastrojejunostomy constricted the jejunum lumen, confirming the diagnosis of intussusception (Fig. 2).
Schematic diagram of the intussusception.. The efferent limb of the gastrojejunostomy had an invagination toward the jejunojejunostomy.
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However, the intussusception could not be resolved, and the CBD stones could not be treated because the invaginated jejunum obstructed the endoscopic approach via the jejunojejunostomy (Fig. 3).
Intraoperative image.. A: Antegrade gastrojejunal intussusception of the afferent loop of the gastrojejunostomy (arrow); B: The replaced jejunojejunostomy site (arrow) showed no ischemic changes or necrosis.
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The intussusception was approximately 5 cm in length, extending from the limb, and was manually reverted (Fig. 4).