P0698 - An Interesting Intermittent Intussusception

Victoria Burris, DO¹, Harrison Pajovich, MD², Erin Hollis, DO², Lauren Davis, DO², Beman wasef, MD², Michael Galperin, MD², Aria Jalalian, MD², Julian Remouns, DO², Nicole Albert, DO^2
1Lankenau Medical Center, Philadelphia, PA; ²Lankenau Medical Center, Wynnewood, PA

Introduction: Intussusception occurs when a segment of bowel telescopes into an adjacent segment causing obstruction. It can present acutely as a surgical emergency due to ischemia or chronically as prandial pain or discomfort . Patients may have intermittent or constant cramping, abdominal pain, nausea, vomiting, bloating, or hematochezia. Gastrojejunal (GJ) intussusception is a rare but potentially life-threatening complication of gastric resection representing 0.01% of postoperative complications. CT is the most sensitive test for pre-operative diagnosis and can often identify pathologic lesions that may act as lead points. Definitive management often requires surgical intervention. As intussusception is rare in the adult population, and symptoms are nonspecific, errors or delays in diagnosis can result.

Case Description/Methods: A 67-year-old female with a history of gastric adenocarcinoma status post subtotal gastrectomy and Roux-en-Y bypass 10 years prior presented with symptoms of nausea, vomiting, and periodic upper abdominal pain over 10 days. CT imaging showed postsurgical changes without evidence of bowel wall thickening. An upper GI series (UGIS) ruled out obstruction. Upper endoscopy demonstrated normal afferent and efferent limbs. However, she continued to have intolerance to enteral feeding leading to a repeat UGIS several days later which revealed a dilated Roux limb and failure of contrast to pass the Jejuno-jejunal anastomosis. Repeat endoscopy revealed intermittent intussusception of the GJ anastomosis with associated dusky intestinal mucosa. After takedown and revision of the Roux-en-Y bypass, upper endoscopy for continued symptoms again showed intussusception with significant edema preventing endoscopic passage as well as several nonbleeding linear gastric ulcers prompting further surgical management.

Discussion: This case underscores the occurrence of intussusception in which surgical intervention can cause anatomical changes of the bowel to act as a lead point. Furthermore, this patient’s subtotal gastrectomy and Roux-en-Y bypass was not recent, nor did the patient have any known history of complications related to her surgery prior to this presentation. Her non-specific symptoms and initial normal UGIS highlight the potential for delayed diagnosis of intussusception, and subsequent complications. Endoscopy is gold standard for diagnosing intussusception in these cases and lack of prompt evaluation increases risk of ischemia. 



Disclosures:


Victoria Burris, DO¹, Harrison Pajovich, MD², Erin Hollis, DO², Lauren Davis, DO², Beman wasef, MD², Michael Galperin, MD², Aria Jalalian, MD², Julian Remouns, DO², Nicole Albert, DO². P0698 - An Interesting Intermittent Intussusception, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.