When a Plication Complicates: Acute Pancreatitis Secondary to Gastroduodenal Intussusception Caused by Redundant GastricPlication

Abstract

Acute pancreatitis is one of the most common gastrointestinal emergencies and has a broad range of etiologies. Gastroduodenal intussusception is an exceedingly rare condition in adults and is most often associated with an underlying structural lesion. Bariatric procedures, including laparoscopic gastric plication, may rarely lead to anatomical alterations that predispose to intussusception. Acute pancreatitis secondary to gastroduodenal intussusception caused by redundant gastric plication is exceptionally uncommon, with only a few cases reported in the literature. Case Presentation: We report the case of a 47-year-old woman with a history of laparoscopic gastric plication who presented with recurrent episodes of acute pancreatitis. Laboratory evaluation revealed pancreatic enzyme levels elevated to more than three times the upper limit of normal. Contrast-enhanced abdominal computed tomography demonstrated findings consistent with gastroduodenal intussusception. Upper gastrointestinal endoscopy confirmed invagination of a redundant gastric plication through the pylorus into the duodenum. Definitive surgical management was achieved with laparoscopic sleeve gastrectomy, resulting in complete clinical resolution. No recurrence of pancreatitis was observed during long-term follow-up. Conclusion: Gastroduodenal intussusception secondary to redundant gastric plication should be considered in the differential diagnosis of acute pancreatitis in patients with a history of bariatric surgery. Early diagnosis using cross-sectional imaging and endoscopy, followed by appropriate surgical intervention, is essential to prevent recurrence and improve clinical outcomes.