Abstract
Internal hernia after gastrectomy is a rare complication. It can progress rapidly to vascular disturbance, necrosis, and perforation, therefore early diagnosis and surgical treatment is essential. We present a case of internal hernia following laparoscopic-assisted proximal gastrectomy with jejunal interposition reconstruction in a 68-year-old man, who presented with acute abdominal pain and vomiting. Computed tomography showed a whirl sign, ascites, and a closed-loop formation of the small intestine. We diagnosed an internal hernia and performed emergency surgery. Laparotomy revealed chyle-like ascites and extensive small intestine with poor color. We recognized that about 20 cm of jejunum from the ligament of Treitz was strangulated behind the pedicle of the jejunum lifted during laparoscopic-assisted proximal gastrectomy. We relieved the strangulation, whereupon the color of the strangulated intestine was restored. Therefore, we did not perform intestinal resection and reconstruction. Finally, we fixed the jejunal pedicle and mesentery of the transverse colon. We report this case as there are few reported cases of internal hernia after laparoscopic-assisted proximal gastrectomy.
Highlights
Laparoscopic gastrectomy for gastric cancer is one of the common treatments for patients with early gastric cancer, in Asia and in Western countries, with numerous clinical series being reported [1,2,3]
Internal hernia is a potential complication known to occur after surgery, which can lead to closed-loop bowel obstruction
One of the forms of internal hernia is Petersen’s hernia, which is an internal hernia that can occur through a mesenteric defect caused by Roux-en Y anastomosis (RY)
Summary
Laparoscopic gastrectomy for gastric cancer is one of the common treatments for patients with early gastric cancer, in Asia and in Western countries, with numerous clinical series being reported [1,2,3]. 6.1 ng/dl 35 U/ml so it is possible that the risk of internal hernia exists at a similar level in both operations This case of internal hernia was formed by passing behind the jejunal pedicle at the side of the laparoscopicassisted proximal gastrectomy (LAPG). Case presentation A 68-year-old man presented with sudden abdominal pain and vomiting The postoperative progress was initially good, with the patient starting to take a meal on the fourth postoperative day He gradually developed abdominal pain and vomiting, which was managed with fasting and fluids. As abdominal CT did not reveal the reason for obstruction, we performed intestinal endoscopy It passed into the area surrounding the jejunojejunostomy, it was very difficult to pass the flexure at this site.
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