Retrograde Gastric Intussusception

Address for Correspondence: Dr. Ural Koç, Department of Radiology, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Turkey Phone: +90 543 367 21 66 e-mail: [email protected] Received: 23 June 2016 Accepted: 7 November 2016 • DOI: 10.4274/balkanmedj.2016.0828 Available at www.balkanmedicaljournal.org Cite this article as: Koç U, Karakaş P. Retrograde Gastric Intussusception. Balkan Med J 2017;34:182-4 ©Copyright 2017 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House. A 15-year-old boy presented to the emergency department with progressive emesis and epigastric pain for two days. Two days earlier, after fairly strenuous exertion, he developed acute epigastric pain radiating to his back and started vomiting. The emesis was initially food material but progressed into dark blood. He had a history of laparoscopic fundoplication and myotomy for achalasia ten years ago. Due to his persistent bolus sensation and difficulty swallowing, an upper gastrointestinal contrast study (Philips Medical Systems 64, Eindhoven, Holland) was performed and revealed a large filling defect causing obstruction at the distal oesophagus together with proximal oesophageal dilatation (Figure 1a. lateral, Figure 1b. anterior posterior view; purple arrow shows the filling defect). Contrast enhancedcomputed tomography (CE-CT) showed all layers of the stomach and omental fat herniated into the lower oesophagus through a hiatal hernia (Figure 2a-d. axial view; Figure 3a-d. sagittal view; pink arrows show stomach layers, blue stars omental fat). CECT scanning was performed in the arterial phase during the first 25-30 seconds of the injection. Intussusception is commonly seen in the small bowel and colon; however, such a process is not ordinarily seen in the gastroesophageal region in children (1). Retrograde gastric 1Department of Radiology, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Turkey 2Clinic of Pediatric Radiology, UCSF Benioff Children’s Hospital, Oakland, California Ural Koç1, Pınar Karakaş2