Pancreaticojejunostomy Obstruction Due to Jejuno-Jejunal Intussusception in the Roux Limb: A Rare Late Complication Following Longitudinal Pancreaticojejunostomy.

Abstract

Lateral pancreaticojejunostomy (LPJ) is done as a decompressive procedure for chronic pancreatitis with dilated main pancreatic duct (MPD) with a success rate of up to 80% in relieving pain with low morbidity and mortality. Roux limb obstruction following Roux-en-Y LPJ is a very rare complication and it has not been described earlier. Here, we report a rare case of pancreaticojejunostomy (PJ) obstruction caused by jejuno-jejunal intussusception in the Roux limb. We present a case of a 31-year-old lady with recurrent episodes of intermittent colicky upper abdominal pain for 8 months. She underwent Roux-en-Y LPJ 20 years back for idiopathic chronic calcific pancreatitis. Her imaging revealed dilated MPD with a dilated Roux limb due to narrowing in the distal roux limb with intussusception. She underwent robotic-assisted resection of jejuno-jejunal intussusception and anastomosis along with cholecystectomy. She recovered well post-operatively and her pain subsided. PJ obstruction following pancreatoduodenectomy has been reported in the literature. However, similar presentation is rare following LPJ. This is the first ever case to be reported with Roux limb obstruction following LPJ. We present this case to emphasise the importance of high-quality imaging in diagnosing this rare case. Robotic-assisted surgery in adults for intussusception is a novel approach and not much discussed in the literature.