title: Obstructive jaundice due to internal herniation: a case report and review of the literature.
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.
authors.affiliation: First Department of Surgery, Sapporo Medical University, Minami 1, Nishi 16, Chuo-ku, Sapporo 060-8543, Japan. masayok@sapmed.ac.jp
authors.forename: Masayo
authors.initials: M
authors.lastname: Kawakami
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Mukaiya
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Fumitake
authors.initials: F
authors.lastname: Hata
authors.forename: Tadashi
authors.initials: T
authors.lastname: Katsuramaki
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Sasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Ura
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000713:Anastomosis, Roux-en-Y; D002768:Choledochostomy; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006555:Hernia, Ventral / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007579:Jejunal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D017562:Postcholecystectomy Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed