A Case of an Afferent Loop Obstruction due to an Internal Hernia After a Distal Gastrectomy with Roux-en-Y Reconstruction

Abstract

We report herein on a case of an afferent loop obstruction due to an internal hernia. A 66-year-old woman had undergone a distal gastrectomy and Roux-en-Y reconstruction for gastric cancer. The patient visited our hospital with acute abdominal pain 3 years after the surgery. The patient was admitted to the hospital for observation under the diagnosis of ileus, but she began to get worse on the following day, and her levels of liver, biliary and pancreas enzymes rose. Computed tomography revealed increased ascites and expansion of the afferent loop, therefore an emergency laparotomy was performed. There was no adhesion in the abdominal cavity, but the whole small intestine had turned to a dark red color with ischemia, following incarceration in the mesentery gap of the jejuno-jejunostomy from the right side to the left side, and afferent loop obstruction had occurred. We pulled out the small intestine from the hernia orifice. The resection of small intestine was not necessary. We closed the hernia orifice with an interrupted suture and finished the operation. The postoperative course was uneventful and the patient was discharged on the 11th postoperative day. It was considered that the mesentery gap of the jejuno-jejunostomy had to be closed when performing a Roux-en-Y reconstruction.