Laparoscopic distal gastrectomy and intra-operative reduction of gastroduodenal intussusception for gastric cancer with ball valve syndrome: A case report with video

Abstract

Gastroduodenal intussusception due to gastric tumours, including gastric cancer, is called ball valve syndrome. Transection of the duodenum is challenging when laparoscopic gastrectomy is performed in patients with ball valve syndrome. An 80-year-old woman with appetite loss was diagnosed with anaemia and gastric cancer and referred to our hospital. Pre-operative examination revealed two gastric cancer lesions in the antrum: one was a 20-mm elevated lesion intussuscepting into the duodenum. Laparoscopic distal gastrectomy with regional lymph node dissection was performed following the clinical diagnosis of early gastric cancer with ball valve syndrome. The prolapsed tumour was moved into the stomach using a pair of laparoscopic forceps and after confirming that the two tumours were present within the stomach using intra-operative endoscopy, the duodenum was transected and Billroth I reconstruction was performed. Gastroduodenal intussusception of small gastric cancers can be managed laparoscopically; however, intra-operative endoscopic confirmation is required to enable duodenal transection.