Abstract
A 66–year–old female patient underwent laparoscope assisted total gastrectomy with retrocolic Roux–en–Y reconstruction for early gastric cancer, and she complained of abdominal pain and vomiting on the 12th postoperative day. Fluoroscopy revealed dilatation and obstruction of the efferent loop. Abdominal computed tomography also showed dilatation of the afferent loop in addition to that of the efferent loop. Conservative therapy using a decompression tube was ineffective, and a reoperation was undertaken on the 21st postoperative day. Laparoscopy revealed that the efferent loop, including part of the jejuno–jejunostomy, had herniated through the mesenteric defect of the transverse mesocolon and caused an obstruction. The efferent loop with part of the jejuno–jejunostomy was pulled out from the mesenteric defect, and the intestinal loop was repositioned laparoscopically. The subsequent operative manipulations were performed laparoscopically. Part of the jejuno–jejunostomy was resected because it was noted to be strictured due to adhesion. The stump of the afferent loop was anastomosed side–to–side with the efferent loop, and both stumps of the efferent loop were anastomosed end–to–end. The efferent loop was then securely fixed by suture onto the transverse mesocolon, and the mesenteric defect was closed. The postoperative clinical course was uneventful, and the patient was discharged on the 21st postoperative day.
It is important to bear in mind the possibility of internal hernia in patients who develop bowel obstruction unresponsive to conservative therapy after laparoscope assisted gastric resection with Roux–en–Y reconstruction.
