Jejunojejunal Intussusception Following Roux-en-Y Gastrectomy for Gastric Adenocarcinoma

Jejunojejunal intussusception is an exceptionally rare but potentially serious complication following Roux-en-Y gastrectomy, with an estimated incidence of 0.4%-0.64%. It most often occurs at the jejunojejunal anastomosis, typically in a retrograde fashion, due to postoperative motility disturbances. Although most cases occur within 2 years postoperatively, delayed presentations several years after surgery can pose diagnostic challenges. We report the case of an 81-year-old male who presented 6 years after D2 subtotal gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma and high-grade neuroendocrine tumor. The patient developed acute-onset, severe colicky abdominal pain with vomiting and distension. Contrast-enhanced computed tomography revealed a "bowel-within-bowel" configuration at the jejunojejunal anastomosis, consistent with intussusception and distal ischemia. Diagnostic laparoscopy confirmed the diagnosis, and due to gangrenous changes in the distal afferent jejunal loop, an open resection with reconstruction of the jejunojejunal anastomosis and gastrojejunostomy was performed. The patient's postoperative recovery was uneventful. This case underscores the importance of maintaining clinical suspicion for intussusception in postgastrectomy patients presenting with acute abdomen, even years after surgery. Early imaging, timely diagnosis, and individualized surgical intervention are essential to prevent morbidity and ensure favorable outcomes.