Abstract
A man in his 80s was brought to our hospital with abdominal pain. He had a history of laparoscopic total gastrectomy and Roux-en-Y reconstruction, and he was urgently operated on after the diagnosis of strangulated bowel obstruction due to internal hernia was made. The small intestine was found near Petersenʼs defect and was markedly congested. After it was repaired, intestinal congestion remained from near the ligament of Treitz to the anastomosis of the Y-leg. Since resection and reconstruction of the area would complicate the procedure and might cause blood flow disturbance to the lifted jejunum, Petersenʼs defect was sutured shut, and a decompression tube was placed in the Y-leg to the third part of the duodenum. The next day, the second-look operation showed improved blood flow in the small intestine. In cases of strangulated bowel obstruction due to Petersenʼs hernia with significant intestinal congestion, placement of a decompression tube and re-evaluation of small bowel blood flow in a second-look operation may be a treatment option.
