A Case of Internal Hernia Incarcerated into the Mesenteric Gap between the Efferent and Afferent Loop after Billroth II Gastrectomy

Kazuo To, Junichi Arai, Yoshihito Shibata, Yasushi Ikuta, Tadayuki Oka and Kenichiro Fukui*

Department of Surgery and Department of Radiology*, National Hospital Organization, Ureshino Medical Center

We report an extremely rare case of internal hernia incarcerated into the mesenteric gap between a gastrojejunostomy and Braun anastomosis after Billroth II gastrojejunostomy. A 76-year-old man who had undergone gastrectomy 40 years earlier and seen for vomiting and regular abdominal colic pain but without metallic sounds or muscular defense was found in abdominal computed tomography to have an almost completely dilated small intestine, suggesting strangulated ileus. Emergency surgery showed almost all of the small intestine to be dilated and dark red. We repositioned the incarcerated intestine by feeding it toward the terminal ileum. The incarcerated intestine fit into the mesenteric gap between efferent and afferent loops taking the form of an internal hernia. No bowel resection was required. The hernia orifice constructed by the mesenteric gap was closed by suturing.

Key words
internal hernia, Braun anastomosis, mesenteric gap

Reprint requests
Kazuo To Department of Surgery, National Hospital Organization Ureshino Medical Center
2436 Shimojuku, Ureshino, 843-0393 JAPAN

Accepted
March 24, 2010

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