Successful Open Abdominal Management in a Case of Strangulated Bowel Obstruction After Distal Gastrectomy with Roux-en-Y Reconstruction

Abstract

A 51-year-old man who had undergone laparoscopic distal gastrectomy (Roux-en-Y reconstruction) for gastric cancer was referred to our emergency room for gradually worsening abdominal pain. As abdominal computed tomography revealed evidence of strangulated bowel obstruction, we performed emergency laparotomy. Intraoperatively, we found that a large segment of the small intestine had herniated through a mesenteric defect formed after a Roux-en-Y anastomosis, with dark red discoloration of the herniated intestine due to strangulation. As resection of such a large strangulated segment of the intestine would result in the short bowel syndrome, we selected open abdominal management (OAM) after releasing the strangulation. By the following day, the color of most of the strangulated segment of the intestine had improved, and only a small segment of the intestine that was persistently ischemic needed to be resected. Although OAM has been used for abdominal trauma, we showed that it could also be useful to manage strangulated bowel obstruction as well as non-obstructive mesenteric ischemia or superior mesenteric artery occlusion, by allowing avoidance of massive small bowel resection.