Abstract
A fifty-five-years-old man was urgently admitted to our hospital under the diagnosis of small bowel obstruction with abdominal pain, nausea, and vomiting. He had a past history of cholangiocarcinoma treated with a left hepatectomy and combined resection of the bile duct 6 months previously. An emergency laparotomy was performed because the diagnosis of strangulation ileus was made by abdominal computed tomography showing marked edema of the small intestinal mesentery and whirl sign, seen as twisting of the mesentery vessels like a spiral. At operation, 120cm of the small intestine had fallen into a 4×3cm defect of the mesentery, located between the Roux-Limb and afferent loop at the jejuno-jejunostomy. Moreover, the affected small intestine was strangulated combined with a 180° clockwise rotation at the site. Fortunately, the affected small intestine had no necrosis. We repaired the internal hernia by repositioning the herniated small intestine, and closed the mesenteric defect. The postoperative course was favorable and he was discharged from the hospital on the 11th postoperative day from surgery. A mesentery defect at a Roux-en-Y jejuno-jejunostomy should be closed if it is possible.
