Case Report of Internal Hernia After Laparoscope-Assisted Distal Gastrectomy for Gastric Cancer

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  • 腹腔鏡補助下幽門側胃切除，Roux-en Y再建術後に発症した内ヘルニアの1例

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Abstract

A man in his 50s who had undergone laparoscope-assisted distal gastrectomy with antecolic Roux-en Y reconstruction for early gastric cancer was admitted urgently with severe abdominal pain on the 122nd postoperative day. Physical examination revealed no signs of peritonitis. Abdominal CT showed a small amount of ascites, dilatation of a part of the jejunum, and edema of the mesentery. Emergency surgery was performed under the suspected diagnosis of strangulated ileus with internal hernia. Almost the entire jejunum was impacted in the space between the transverse colon and the elevated jejunum via the antecolic pathway, consistent with Petersen's hernia. Ischemic changes were found in the herniated jejunum, which disappeared immediately after manual reduction of the herniated jejunum. Thereafter, the defect of the mesentery was closed. The patient was discharged on the 7th postoperative day. This case underscores the importance of bearing in mind the possibility of occurrence of internal hernia in patients undergoing laparoscope-assisted gastric resection with Roux-en Y reconstruction.

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