Retrograde jejunogastric intussusception (JGI) with strangulation following previous gastrojejunostomy.

Jejunogastric intussusception is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. A young man presented with epigastric pain and bilous vomiting followed by haematemesis 15 years after vagotomy & gastrojejunostomy for chronic duodenal ulcer. At presentation the patient was in shock and an emergency laparotomy was done after resuscitation. At laparotomy a retrograde type II JGI was found and managed by resection of the affected segment and partial gastrectomy and jejuno - jejunostomy with closure of the duodenal stump. Postoperative recovery was uneventful. Retrograde JGI is a rare condition and only less than 200 cases have been reported since its first report. Clinical picture of acute intestinal obstruction with suspicion about the condition in patients having a past history of gastrojejunostomy makes the elusive diagnosis definite and demands early surgery to reduce the grave consequences of the disease.

Leiomyoma of the urinary bladder.

Benign mesenchymal tumors of the bladder are rare and comprise less than 1% of the all bladder neoplasms. Leiomyoma is the most common type and comprises 35% of these tumors. These tumors may develop in submucosal (63%), intramural (7%) or subserosal (30%) layer, at any region of the bladder. The clinical presentation is varied and may include obstructive symptoms(50%), irritative symptoms (38%) and hematuria (11%). There are asymptomatic cases (19%), which make the diagnosis more difficult. Occurs more frequently in women than in men (3:1). The most common diagnostic investigations are ultrasonography, intravenous urography, computerized tomography scan and the magnetic resonance imaging. A 66 year old man presented with long standing voiding obstructive symptoms. Various examinations were performed in the last 2 years and was diagnosed either prostatic enlargement or bladder tumor. Cystoscopy was not available for confirming the diagnosis. The surgical exploration revealed a well-circumscribed mass at the bladder neck with moderate enlargement of the prostate. The pathological examination revealed a leiomyoma of the bladder. The post operative period was uneventful and the patient is doing well, without recurrence of the symptoms.