Abstract
We report here five cases of internal hernia with ileus after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Primary surgeries for gastric cancer were total gastrectomy in two cases, distal gastrectomy in two cases, and laparoscopically assisted distal gastrectomy in one case. All patients suffered from upper abdominal pain and vomiting, and CT scan showed dilation of the upper jejunum and the whirl sign (twisting of mesenteric vessels). Operative findings revealed a jejunum to be strangulated through the mesentery defect of Roux-en-Y anastomosis in all five cases. Emergency open surgery was carried out in three patients and one patient of them needed resection of the jejunum due to ischemic change. Elective laparoscopic surgery was performed in the remaining two patients whose symptoms were mild and repeated. We replaced the strangulated jejunum through the mesenteric defect and closed the hernia orifice in all cases, and no recurrence has occurred in them. In our hospital, the incidence of internal hernia after gastrectomy with Roux-en-Y reconstruction for cancer is 1.6% (5/313) for recent two years. Closure of the mesentery defect of Roux-en-Y anastomosis was not done in all these five cases. We conclude that complete closure of the mesentery defect of Roux-en-Y anastomosis is mandatory in employing Roux-en-Y reconstruction for cancer gasrectomy.
