Abstract
A 66-year-old man presented with sudden onset of upper abdominal pain. Laparoscopic total gastrectomy with D2 lymph node dissection, splenectomy and Roux-en Y (overlap) reconstruction had been performed for advanced gastric cancer 1 and half year before. Abdominal CT scan showed a dilated small intestine prolapsed into the mediastinum through the esophageal hiatus not involving the anterior heart. Ischemia of the prolapsed small intestine was suspected, because of poorly enhanced images of the bowel wall. Strangulation ileus caused by esophageal hiatal hernia was diagnosed, and an emergency operation was performed under laparoscopy. After successfully reducing the prolapsed small intestine back to the abdominal cavity, the necrotic part of the intestine was resected. This case was considered to be rare, but specific to the laparoscopic surgery for gastric cancer.
