An Internal Hernia After an Open Total Gastrectomy Presenting as an Acute Mesenteric Ischemia Case Report

Abstract

A 78-year-old female had a history of an open total gastrectomy and Roux-en-Y reconstruction for gastric cancer two years prior to admission. She was transferred to our medical center with the chief complaint of acute abdominal pain with vomiting. Contrast-enhanced abdominal CT demonstrated a lack of bowel-wall enhancement from the Roux limb to the transverse colon with interruption of the superior mesenteric artery. We performed an emergency laparotomy under the diagnosis of superior mesenteric arterial occlusion and found a herniation of the small intestine into the space dorsal to the Roux limb. The reduction of the herniation restored the blood flow and intestinal resection was avoided. The mesentric ischemia was probably caused by the torsion of the superior mesentric artery. The lesson is that an internal hernia is one of the important complications of Roux-en-Y reconstruction and it can present as acute mesentric ischemia.