Internal Hernia within the Mesenteric Gap between a Gastrojejunostomy and a Braun Anastomosis after Subtotal Stomach-preserving Pancreaticoduodenectomy

Abstract

A 74-year-old man underwent subtotal stomach-preserving pancreaticoduodenectomy for extra-hepatic cholangiocarcinoma at our hospital. After surgery, the patient experienced vomiting and had a nasogastric tube inserted. Contrast-enhanced computed tomography revealed stenosis at the efferent loop (anal side) of the Braun anastomosis and the ileus in this area. Upper gastrointestinal endoscopy confirmed stenosis at the efferent loop (anal side) of the Braun anastomosis. We diagnosed an obstructed ileus via constriction at the Braun anastomosis, so the area underwent reoperation. Operative findings revealed an internal hernia in the efferent loop of the Braun anastomosis penetrating the mesenteric gap between the gastrojejunostomy and the Braun anastomosis. We released the jejunal loop from the mesenteric gap and sutured the gap closed. The patient was discharged 16 days after surgery with no postoperative complications. Six months after surgery, the patient had no abdominal symptoms and had a good appetite. Internal hernia in the mesenteric gap between a gastrojejunostomy and a Braun anastomosis after pancreaticoduodenectomy is rare. We present a case report and literature review.