Efferent Loop Jejunogastric Intussusception Following Gastrojejunostomy: A Rare Late Complication

Abstract

Jejunogastric intussusception is an uncommon complication of gastric surgery in which a jejunal segment telescopes into the stomach through a gastrojejunal anastomosis. Efferent-loop involvement may present with intermittent and non-specific symptoms, making recognition difficult long after the original operation. This case report describes the presentation, diagnostic assessment, operative management and postoperative course of a patient with delayed efferent-loop jejunogastric intussusception. A 54-year-old woman presented with three months of recurrent, predominantly postprandial, non-bilious vomiting, upper abdominal pain and episodic epigastric cramping. She had undergone open gastrojejunostomy for peptic ulcer disease 15 years earlier and had remained asymptomatic until the current illness. Examination identified epigastric tenderness, with haemodynamic stability. Contrast-enhanced computed tomography demonstrated an intragastric target-shaped and sausage-shaped lesion formed by a jejunal loop passing retrogradely through the gastrojejunostomy. Upper gastrointestinal endoscopy showed a congested, oedematous jejunal loop protruding into the stomach, with visible mucosal folds and preserved peristalsis. At exploratory laparotomy, retrograde intussusception of the efferent loop was confirmed. The bowel remained viable, permitting gentle manual reduction and jejunopexy without resection. Postoperative recovery was uneventful, and no recurrence was reported during follow-up. This case illustrates how combined clinical assessment, cross-sectional imaging and endoscopy can support diagnosis of delayed jejunogastric intussusception, while operative assessment of bowel viability guides the extent of surgical treatment.