A Case of Gastrostomy Repositioning Using Hunt–Lawrence Pouch for Internal Hernia Caused by Gastrostomy and Scoliosis

Abstract

The patient was an 18-year-old boy who underwent Nissen’s fundoplication and gastrostomy at the age of 12 owing to difficulty in swallowing due to cerebral palsy and epilepsy. He underwent emergency hospitalization due to ileus. Because of his severe scoliosis, the small intestine had developed an internal herniation in the space between the right costal arch, the right ilium, and the gastrostomy, resulting in intestinal necrosis. After that, the bowel obstruction was repeated. We considered that the position of the gastrostomy was the cause of the repeated bowel obstruction, so we repositioned the gastrostomy. Owing to his severe scoliosis, simple repositioning of the gastrostomy was difficult, so a Hunt–Lawrence pouch was formed and a replacement gastrostomy was constructed in the jejunum pouch to reconstruct the gastrostomy. Alternative gastrostomy using a Hunt–Lawrence pouch can be an option for patients who have difficulty with gastrostomy repositioning due to scoliosis or who have gastrostomy complications.