case_images: PMC10849266_01
case_images: Type II Billroth reconstruction after pancreatoduodenectomy.. The classic sequence of Child's procedure used in this surgery consisted of the following order: (1) retrocolic pancreaticojejunostomy modified Blumgart anastomosis ductal-to-mucosa with external stent; (2) bilioenteric hepaticojejunal end-to-side transmesocolic anastomosis; and (3) gastrojejunal end-to-side antecolic and retrogastric anastomosis with automatic stapler. The afferent loop (red arrow), efferent loop (green arrow), and blue arrow show the direction of intussusception.
case_images: cureus-0016-00000051880-i01.jpg
case_images: PMC10849266_01_cureus-0016-00000051880-i01.jpg
case_images: FIG1
case_images: Medical history included the surgical antecedent of having a PPPD, also known as a Traverso-Longmire procedure with a Child's procedure (Figure 1).
case_images: Abdominal CT.. Contrasted abdominal axial CT showing intestinal intussusception at the level of the gastrojejunal anastomosis within the stomach (circle), without subdiaphragmatic free air. (A) axial section. (B) Coronal reconstruction.
case_images: cureus-0016-00000051880-i02.jpg
case_images: PMC10849266_01_cureus-0016-00000051880-i02.jpg
case_images: FIG2
case_images: A CT scan showed a characteristic mass lesion containing fat stripes, suggestive of an intussusception site at the level of the gastrojejunal anastomosis, without evidence of air or free fluid in the abdominal cavity (Figure 2).
case_images: Site of the intussusception.. Invagination of the efferent loop (A) into the stomach (B) through the jejunogastric anastomosis Brynits 2A/Shackman 2A.
case_images: cureus-0016-00000051880-i03.jpg
case_images: PMC10849266_01_cureus-0016-00000051880-i03.jpg
case_images: FIG3
case_images: Efferent loop.. Middle jejunum with a necrotic appearance.
case_images: cureus-0016-00000051880-i04.jpg
case_images: PMC10849266_01_cureus-0016-00000051880-i04.jpg
case_images: FIG4
case_images: Hutchinson maneuver was tried but was unsuccessful because of the edema present at the time of the surgery; hence, a gastrostomy of the anterior wall and a transgastric intestinal exteriorization was realized with a mechanical resection of 45 cm of the middle jejunum, which showed a congested and devascularized appearance and vascular compromise of the mesentery (Figures 4, 5).
case_images: Necrotic middle jejunum.. Macroscopic vision of the necrotic middle jejunum.
case_images: cureus-0016-00000051880-i05.jpg
case_images: PMC10849266_01_cureus-0016-00000051880-i05.jpg
case_images: FIG5
case_images: Hutchinson maneuver was tried but was unsuccessful because of the edema present at the time of the surgery; hence, a gastrostomy of the anterior wall and a transgastric intestinal exteriorization was realized with a mechanical resection of 45 cm of the middle jejunum, which showed a congested and devascularized appearance and vascular compromise of the mesentery (Figures 4, 5).