A Case of a Difficult-to-Diagnose Internal Hernia after Gastrectomy with Roux–en–Y Reconstruction

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 39; no. 4; pp. 747 - 749
• Main Authors: Nishimura, Kodai, Sakamoto, Eiji, Norimizu, Shinji, Otsuji, Hidehiko, Yonekawa, Yoshihiko, Suzuki, Akira
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 31.05.2019
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.39.747

A 69-year-old man had undergone laparoscopic distal gastrectomy with a retrocolic Roux–en–Y reconstruction for early gastric cancer in our hospital. He visited our hospital with abdominal pain 2 years after the surgery. CT revealed dilation of the Roux limb and afferent loop. We suspected an internal hernia without ischemia, and performed decompression with an ileus tube. Although the clinical symptoms were relieved by conservative treatment, a follow-up CT showed the internal hernia persisted. An operation was performed and revealed that almost the entire small intestine including the afferent loop had been affected due to a widely dilated defect at the transverse mesocolon. In addition, a part of the small intestine was impacted in the mesenteric defect at the dorsal aspect of the Y-anastomosis. Since no ischemic changes were observed, the intestine was preserved. The internal hernia was therefore reduced and these defects were repaired with suture closure. There has been no recurrence of the internal hernia after the surgery.