診断に難渋した腹腔鏡補助下残胃全摘術後に繰り返した内ヘルニアの1例

Abstract

We report a case of internal hernia that was difficult to diagnose in long-term follow-up after laparoscopy-assisted total gastrectomy for remnant gastric cancer. A 75-yearold man, who had undergone laparoscopy-assisted total gastrectomy for remnant gastric cancer with antecolic Roux-en-Y reconstruction after open distal gastrectomy for a gastric ulcer, frequently presented slight temporary postprandial abdominal pain. His symptom was, however, reduced by diet therapy. After being discharged from hospital, he continued to complain of slight abdominal pain. He was admitted to our hospital with postprandial abdominal pain four months after surgery. An upper gastrointestinal study and abdominal CT could not reveal the cause of his symptom. His symptom was getting gradually worse, and we decided on surgical exploration of the abdominal cavity. The day before the operation, CT showed mesenteric vessel twisting for the first time. The operative findings revealed the entire small intestine had herniated through a mesenteric defect of jejunostomy. The herniated intestine had no ischemic change. It was repaired manually, and the defect was closed by interrupted suture. It is important to consider internal hernia for patients with nonspecific abdominal pain who have undergone laparoscopy-assisted gastrectomy with Roux-en-Y reconstruction.