Laparoscopic Internal Hernia Reposition after Laparoscopy-assisted Distal Gastrectomy with Roux-en-Y Reconstruction

Hiroyuki Yamada, Kazuyuki Kojima, Mikito Inokuchi, Keiji Kato, Syo Otuki, Yoshitaka Hujimori, Tatsuyuki Kawano and Kenichi Sugihara*

Department of Esophagogastric Surgery, Tokyo Medical and Dental University Hospital of Medicine
Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University*

After undergoing laparoscopy-assisted distal gastrectomy with antecolic Roux-en-Y reconstruction for early gastric cancer, a 49-year-old woman was seen for dull abdominal pain and epigastric discomfort. Her abdomen was not distended and no gross peritoneal signs were seen beyond midabdominal tenderness upon palpation. Plain abdominal radiography showed no bowel obstruction, but abdominal computer tomography showed bowel and mesenteric vessel twisting (whirl sign). When conservative treatment based on a diagnosis of internal hernia was unsuccessful, we conducted laparoscopic surgery the next day, finding that the entire small intestine from the jejunojejunostomy to the end of the ileum had herniated through the Petersen's defect and was misplaced on the left side of the abdomen. With drawing the small intestine from the Petersen's defect and repositioning it laparoscopically obviated intestinal resection since the herniated intestine had no ischemic change. Internal hernia following distal gastrectomy is rare, but the incidence of Petersen's hernia is expected to increase with the increasing incidcence of Roux-en-Y reconstruction. Prompt diagnosis remains the most important factor in reducing internal hernia morbidity.

Key words
Roux-en-Y reconstruction, internal hernia, laparoscopic gastrectomy

Reprint requests
Hiroyuki Yamada Department of Esophagogastric Surgery, University Hospital of Medicine, Tokyo Medical and Dental University
1-5-45 Yushima, Bunkyo-ku, 113-8519 JAPAN

Accepted
January 27, 2010

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