Background

Adult intussusception is a diagnostic challenge given its non-specific presentation and rarity with a prevalence of only 5% of all intussusceptions and 1% of all bowel obstructions. Malignant neoplasms are the most frequent etiology, accounting for 90% of intussusceptions. We present a case of a 52 year old woman with history of Roux-en-Y gastric bypass in 2006, complicated by small bowel intussusception requiring revision in 2015, who arrived to the ED complaining of postprandial nausea and abdominal pain. CT A/P showed a retrograde intussusception occurring in the biliopancreatic limb (BPL). In this case, the patient was taken to the operating room and a midline laparotomy was performed. A jejunojejunal retrograde intussusception of the BPL was confirmed. The alimentary and biliopancreatic limb anastomoses to the common channel were then resected. Reconstruction was performed between the distal small bowel and alimentary limb in an antiperistaltic fashion. Fifty cm distal to this anastomosis, a second isoperistaltic small bowel anastomosis between the common channel and the BPL was created. A gastrostomy tube was placed in the remnant stomach to aid in post-operative nutrition optimization. Post-operative recovery was uneventful. Patient was discharged on postoperative day 4 on nightly tube feeds. At 2-week follow-up, the patient reported tolerance of diet, no recurrent pain, and 4 lbs weight gain. With the recent increase in gastric bypass surgeries, bowel anastomoses should be considered leading points for initial and recurrent intussusceptions. Studies evaluating outcomes of isoperistaltic vs antiperistaltic configurations could help establish guidelines to minimize long-term post-operative complications.