[Intussusception after Billroth II operation fifty years ago - an unusual cause for ileus]

A 77-year-old woman presented with occasional vomiting of hematin but no further complaints. 50 years ago a partial gastrectomy after Billroth II had been performed due to a gastric ulcer.

The physical examination revealed no pathologic findings. All laboratory values, including hemoglobin (HB), were in normal range. The gastroscopic examination showed traces of hematin in the stomach and in the efferent and afferent loop.  The Braun anastomosis could not be delineated. No other pathologic findings were noted.

At the request of the patient additional regular controls of hemoglobin were planned on an outpatient basis. In case of hemoglobin decrease, further treatment should be arranged. Two days after discharge the patient was presented with sudden massive abdominal pain and vomiting. Clinical examination confirmed the assumption of mechanical ileus. An emergency abdominal CT showed an intussusception of a small bowel loop into the Braun anastomosis as the ileus trigger. A laparotomy was carried out immediately after the CT. Because of severe ischemic damage of the intussuscepted loop, an "en bloc" resection of the loop including the Braun anastomosis including reanastomosis had to be carried out.

Intussusception is primarily a childhood disease, occurring in adults only in about 5% of cases. Postoperative intussusception is a rare complication after gastric surgery.Especially because of its exceptionality the diagnosis of intussusception in adulthood can be difficult. Crucial herein is to have intussusception in mind in the differential diagnostic pathway of a post gastric surgery ileus.