Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 838360, 3 pages http://dx.doi.org/10.1155/2013/838360 Case Report Jejunogastric Intussusception: A Rare Complication of Gastric Surgery Gokhan Cipe, Fatma Umit Malya, Mustafa Hasbahceci, Yeliz Emine Ersoy, Oguzhan Karatepe, and Mahmut Muslumanoglu Bezmialem Vakıf University, Department of General Surgery, 34093 Istanbul, Turkey Correspondence should be addressed to Fatma Umit Malya; fumitm@gmail.com Received 7 April 2013; Accepted 29 May 2013 Academic Editors: N. Nissen and Y. Takami Copyright © 2013 Gokhan Cipe et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jejunogastric intussusception is a rare complication of gastric surgery. It usually presents with severe epigastric pain, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate and early diagnosis which calls forth an urgent surgical intervention. Only reduction or resection with revision of the previously performed anastomosis is the choice which is decided according to the operative findings. We present a case of JGI in a patient with a history of Billroth II operation diagnosed by computed tomography. At emergent laparotomy, an efferent loop type JGI was found. Due to necrosis, resection of the intussuscepted bowel with Roux-en-Y anastomosis was performed. Postoperative recovery was uneventful. 1. Introduction Jejunogastric intussusception (JGI) is a rare complication of gastrectomy with an incidence of 0.1% [1]. It is thought that it can occur any time aſter several types of the gastric operations including gastrojejunostomy and Billroth II resection [2–4]. A mortality rate of 10% and even as high as of 50% has been reported if surgical intervention has been delayed [5, 6], therefore, early diagnosis of this condition is mandatory. Although a history of gastric surgery may help in making such a diagnosis, preoperative awareness of this condition has been reported to be difficult in most of the cases. In this paper, we aim to report a case of JGI with regard to its presentation, diagnosis, and surgical treatment. 2. Case Report A 63-year-old male patient was admitted to the hospital with severe colicky epigastric pain followed by hematemesis. ere was a past history of gastric surgery (Billroth II operation), which had been performed 23 years previously for peptic ulcer disease. On physical examination, there was a mildly distended abdomen, epigastric tenderness, and a vague feeling of an epigastric mass on deep palpation. e usual laboratory investigation was unremarkable. A com- puted tomography showed a distended stomach containing a nonhomogeneous mass (Figure 1). e diagnosis of JGI was established, and an emergent laparotomy was performed. At laparotomy, an ischemic efferent loop was found to be intussuscepted in a retrograde manner into the gastric lumen (Figures 2 and 3). Following reduction of this jejunal segment, resection with Roux-en-Y anastomosis was performed due to ongoing necrosis (Figure 4). e patient was discharged at the fiſth postoperative day without any complaint. 3. Discussion e term retrograde intussusception (invagination) was first introduced by John Hunter to define an invagination of the intussusceptum in an antiperistaltic or proximal direction as opposed to the usual peristaltic or distal direction [7]. Intussusception is an uncommon condition that may arise at any age. It is usually seen in childhood, and only 5% of cases occur in adults [8]. Jejunogastric intussusception is a rare complication of gastrojejunostomy, Billroth II gastrec- tomy, and Roux-en-Y anastomosis. ere were less than 200 published cases since its first description in 1914 by Bozzi in a patient with gastrojejunostomy [3]. In 1922, Lundberg