Obstructive jaundice due to internal herniation: a case report and review of the literature |
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Authors: | Kawakami Masayo Mukaiya Mitsuhiro Kimura Yasutoshi Hata Fumitake Katsuramaki Tadashi Sasaki Kazuaki Ura Hideki Hirata Koichi |
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Affiliation: | First Department of Surgery, Sapporo Medical University, Minami 1, Nishi 16, Chuo-ku, Sapporo 060-8543, Japan. masayok@sapmed.ac.jp |
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Abstract: | A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier. A computed tomography scan revealed a dilated afferent loop and dilated intrahepatic bile duct. Upper gastrointestinal examination with contrast medium and percutaneous transhepatic cholangiography showed a high intestinal obstruction around the jejunojejunal anastomosis. The patient underwent laparotomy based on a diagnosis of obstructive jaundice due to ileus. During the operation, he was found to have internal herniation of the small bowel through a rent in the mesentery around the Roux-en-Y anastomosis for choledochojejunostomy. The hernia was reduced, and bowel resection was performed due to stenosis of the afferent loop. Jejunojejunal anastomosis was re-performed and the defect in the mesocolon was closed. Internal herniation after Roux-en-Y anastomosis is a rare sequela, but it should be recognized that this complication can occur after Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric defects is important. |
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