A case report of jejunogastric intussusception complicated by torsion: 17 years after subtotal gastrectomy.

Jejunogastric intussusception (JGI) with torsion is a rare but life-threatening late complication after gastrectomy. We report a 65-year-old man who presented with acute epigastric pain, vomiting, and hematemesis 17 years after subtotal gastrectomy with retrocolic Billroth 2 reconstruction. Abdominal CT showed JGI with a target-like lesion and a whirl sign near the gastrojejunostomy, suggesting associated torsion and threatened bowel viability. Emergency laparotomy revealed extensive adhesions, 360° clockwise torsion of the efferent loop, and efferent-loop intussusception with retrograde herniation into the remnant stomach, resulting in severe edema, incarceration, ischemia, and necrosis. After adhesiolysis, abdominal reduction was unsuccessful; therefore, gastrotomy-assisted reduction, resection of the necrotic bowel, and side-to-side jejunojejunostomy were performed. The patient recovered uneventfully and was discharged on postoperative day 10. At 6-month follow-up, he remained asymptomatic, and contrast-enhanced CT showed no recurrent torsion or intussusception. This case highlights that JGI with torsion should be considered in patients with a history of gastrectomy who develop acute abdominal pain, vomiting, or hematemesis, even many years after surgery. Prompt CT-based diagnosis and definitive surgical treatment are essential when ischemia is suspected.