Abstract
An 86-year-old man was admitted to a local hospital because of abdominal pain, vomiting, and abdominal distention. He had undergone distal gastrectomy for gastric cancer when he was 67 years old. Abdominal radiograph examination revealed a markedly dilated intestine. Sigmoid colon volvulus was suspected on the basis of colonoscopy. Reduction of the torsion was attempted through colonoscopy but was not successful. As it appeared that surgical detorsion was necessary, he was referred to our hospital. Abdominal CT revealed a large amount of free air and ascites. Under the preoperative diagnosis of diffuse peritonitis, an emergency operation was performed. During the operation, we found that the patient had a long transverse colon that had adhered to the operation scar and had bent and that a hiatus had been formed because of the bending of the colon. The small intestine had prolapsed through the hiatus and had been incarcerated in the form of an internal hernia. The transverse colon had twisted 180°because of the friction of the prolapse, with necrosis. After detorsion, resection of the transverse colon and colostomy were performed. We have reported this case because cases of volvulus of the transverse colon with internal hernia occurring after gastrectomy are very rare.
