A Case of Internal Hernia after Hepaticojejunostomy with Roux-en-Y Reconstruction

Abstract

A 67-year-old man underwent extended right lobectomy with extrahepatic bile duct resection for gallbladder cancer, followed by biliary reconstruction with antecolic Roux-en-Y hepaticojejunostomy. Eight months after the operation, he presented to our hospital with abdominal pain, vomiting and loss of appetite. A computed tomography scan indicated bowel obstruction (subileus) due to a twisted small bowel, and operation was performed. On exploration, few intraperitoneal adhesions were observed and we diagnosed the case as an internal hernia of the small intestine through the space between the mesentery of the Roux limb and the transverse mesocolon (Petersen's defect). The small intestine was twisted to disturb smooth flow of the content, but neither obstructed nor ischemic. We repositioned the incarcerated bowel loop and closed the Petersen's defect by suturing. Here, we report a rare case of internal hernia after biliary surgery, along with a review of the relevant literature.