Retrograde Jejunogastric Intussusception (RJGI): A Life- Threatening Complication after Gastric Bypass Surgery

Retrograde jejunogastric intussusception (rjgi) after gastric bypass surgery is a rare but potentially life threatening complication. this complication may develop after simple gastrojejunostomy, after lower partial resection of stomach with gastrojejunostomy (billroth-ii gastric surgery) or after roux-en-y gastric bypass. among the three anatomic type ofjejunogastric intussusception (jgi), type-ii is the commonest variety. the acute form is a surgical emergency. mortality rate is very high. little is known about the mechanism but many literatures indicate abnormal motility may be a cause. a 50 year old male presented to us with a three month history of repeated vomiting and one day of upper mid-abdominal pain. he had a history of gastric bypass for pyloric stenosis 12 years back. diagnosis was confirmed by upper gi endoscopy. at laparotomy type ii retrograde jejunogastric intussusception was identified. en-block resection of affected segment of jejunum and lower part of the stomach was done followed by roux-en-y reconstruction. rjgi is a rare complication of gastric bypass surgery. early diagnosis is imperative. high index of suspicion is therefore important. barium meal x-ray, ultra sonogram, enhanced ct scan occasionally be diagnostic, but endoscopy is certainly diagnostic in experienced hand. laparotomy is mandatory. surgical options include simple reduction, en-block resection and/or plication.