2017 Volume 37 Issue 3 Pages 479-482
A 76-year-old woman was admitted to our emergency center with back pain and nausea. She had undergone a laparoscopic distal gastrectomy with an antecolic Billroth Ⅱ reconstruction for gastric cancer two years previously. An abdominal computed tomographic scan revealed an internal hernia and volvulus of the efferent loop. Ascites were also observed. We performed an emergency operation. The intraoperative findings showed chylous ascites and torsion of the efferent loop into the space between the mesentery of the B-Ⅱ limbs and the transverse mesocolon. We released the strangulation of the efferent loop. Because the intestinal blood flow was good, we finished the operation without performing an intestinal resection. Internal hernia with chylous ascites after gastrectomy is rare, especially in cases with a Billroth Ⅱ reconstruction. Although an emergency operation is needed for the correction of an internal hernia and volvulus with ascites, the intestinal blood flow is often preserved if chylous ascites are observed. Thus, the presence of chylous ascites might be an indicator that intestinal resection is unnecessary.
