title: Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group's experience of 23 cases.
abstract: BACKGROUND
  Retrograde (reverse) intussusception of the jejunum is thought to be a very rare occurrence, having been reported approximately 15 times (21 patients) in medical studies. A review of our own experience of >15,000 Roux-en-Y gastric bypass patients found 23 cases treated since 1996. This is the largest single-center report to date.
  
  
  METHODS
  A chart review dating back to 1996 revealed 23 patients with retrograde intussusception involving the jejunum. Their charts were reviewed. A variety of data was reviewed to identify the risk factors for developing intussusception, as well as the presentation, findings, and treatment.
  
  
  RESULTS
  We identified 23 patients with retrograde intussusception involving the jejunum. Of these 23 patients, 22 had undergone Roux-en-Y gastric bypass. One patient had undergone Roux-en-Y choledochojejunostomy. Of the 23 patients, 1 (4%) had a gastrojejunal intussusception and 22 (96%) jejunojejunal intussusceptions. All patients were women, with a median age of 32 years (range 20-50). The mean body mass index at gastric bypass was 45.2 kg/m2 (range 39.4-55). Of the 23 patients, 19 (83%) had undergone open and 4 (17%) laparoscopic gastric bypass. The median duration from gastric bypass to the diagnosis of intussusception was 51 months (range 6-288). Of the 23 patients, 8 (35%) presented with gangrene, perforation, or nonreducable obstruction, 9 (39%) had a spontaneous reduction, and in 6 (26%), the obstruction was successfully reduced at surgery. The treatment was surgical resection in 16 (70%) with 2 recurrences (12.5%), simple reduction in 2 (9%) with 100% recurrence, and plication in 5 patients (22%) with 2 recurrences (40%).
  
  
  CONCLUSIONS
  Retrograde intussusception of the jejunum after gastric bypass is probably more common than previously believed. Although resection and revision of the area of intussusception appears to be effective, more information is needed about the treatment and possible prevention of this disorder.
authors.affiliation: Rocky Mountain Associated Physicians, Salt Lake City, Utah 84124, USA. ssimper@rmapinc.com
authors.forename: Steven C
authors.initials: SC
authors.lastname: Simper
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Erzinger
authors.forename: Rodrick D
authors.initials: RD
authors.lastname: McKinlay
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Smith
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007443:Intussusception / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007579:Jejunal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D014589:Utah / Q000453:epidemiology