X線および内視鏡的に術前確診された逆行性空腸胃重積症の1例

Retrograde Gastrojejunal Intussusception, a Case Report: Preoperatively confirmed as such by x-ray and endoscopy

　胃切除後の合併症として，ダンピング症候群，輸入脚症候群，吻合部潰瘍などがよく知られている．われわれは極めてまれとされる残胃内への逆行性空腸重積症（retrograde jejunogastric intussusception）の1例を経験した．胃X線透視にて術前に確定診断し，併せて緊急内視鏡検査にて，その劇的な像を鮮やかに捕らえることができたので若干の文献的考察を加えて報告する．

　The patient, a 55 year-old man, had undergone gastrectomy (gastrojejunal anastomosis by Billroth Ⅱ method, the anastomosis being in front of the colon without Braun's anastomosis) 20 years before under a diagnosis of gastric cancer. He came to our hospital because of sudden colic in the upper abdomen. He had frequent bouts of hematemesis. We palpated a tumor in the upper abdomen. At admission the most probable diagnosis was acute abdomen. X-ray examination of the stomach on the following day showed that the contrast medium (Gastrografin) did not at all flow down to the small intestine, and a large spherical shadow defect was seen in the gastric remnant. As the shadow defect showed laminated annular folds, we made a diagnosis of retrograde jejunogastric intussusception. Emergency endoscopy of the stomach was done to confirm our diagnosis. The remnant stomach was unexpectedly clean probably owing to frequent vomiting. The impacted jejunum up through the site of anastomosis displayed an impressive picture: it was like bellows, engorged and swollen, dark purplish red. The overall picture clearly showed a need for emergency operation, which was done 30 hours after the onset of the symptoms. On laparotomy the efferent loop of the jejunum was impacted in the gastric stump. A part of the intussuscepted jejunal loop was necrotized and perforated, so that we resected the affected segment along with a part of the remnant stomach followed by gastrojejunal anastomosis and end-to-end jejunal anastomosis.

　The postoperative course was uneventful. The patient was discharged 30 days after the operation.

　Among postgastrectomy complications retrograde intussusception of the jejunum is of very rare occurrence. There are only two such reports in Japan and 170 in the world until 1971. We have made a report here with its clinical characteristics, cause and incidence with some reference to the literature.