Internal herniation following gastrectomy: Report of two cases and literature review

Abstract

Objective: Internal hernia following gastrectomy is an uncommon disease. Preoperative diagnosis is difficult because clinical symptoms are nonspecific. However, it is a surgical emergency, accurate preoperative diagnosis is crucial for appropriate management. Multidetector computed tomography (CT) plays an essential role in preoperative diagnosis of internal hernias.

Methods: Describing 2 cases, at Thong Nhat Hospital, Ho Chi Minh City. All patients went preoperative CT and proved surgically internal hernias: Peterson hernia, J-J hernia.

Results: The combination of mesenteric swirl sign and small bowel obstructioon has the highest sensitivity and accuracy for internal hernia following gastrectomy. “Sandwich sign” an interposed small bowel between transverse colon and gastrojejunostomy’s limb can be a predictor of Peterson hernia. Meanwhile, the positon of hernia orifice, which is close to the position of J-J anastomosis and the displacement of J-J anastomosis out of the left-mid abdomen can predict J-J hernia.

Conclusions: Multidetector computed tomography (CT) plays an essential role in preoperative diagnosis of internal hernias following gastrectomy.