A case of internal hernia after total gastrectomy and roux-y anastomosis

Abstract

A 65-year old man was consulted to the emergency department of our hospital with a chief complaint of sudden abdominal pain. He was alert, had diffuse abdominal pain, and showed slight peritoneal signs. He had undergone total gastrectomy with Roux-Y reconstruction. The liver function was slightly impaired and the serum amylase level was markedly increased. Abdominal CT with contrast showed dilatation of the intestine and wall thickening of the intestine in the left abdomen, but blood flow in the intestinal wall was maintained. A long tube was inserted. Abdominal pain was still present five hours after admission, and abdominl CT was performed, whic revealed the dilatation of duodenum to anastomosis site of the small intestine. Intraoperative findings showed that the small intestine on the anal side was tucked inward to the space between the mesenterys at the afferent small bowel anastomosis site, and it had caused the internal hernia. As bowel necrosis was not observed, the intestine was restored, hernial orifice was closed, and surgery was completed. There are few reported cases of internal hernia after total gastrectomy, and so we report this case, along with a literature review.