Internal hernias after gastric operations

From a total of 2,146 oesophagojejunal and gastrojejunal anastomoses done between 1969 and June 1990, 7 patients (0.3%) were operated on for internal hernias. Six had developed their hernias after Billroth II gastrectomy with antecolic gastrojejunostomy and enteroanastomosis, and one patient after retrocolic Roux-en-Y reconstruction. The patients were operated on 5 days-27 years after their first operations. No patients developed internal hernias after simple gastrojejunostomy or after operations for malignant disease. Two patients died (29%) and three others developed complications. Five patients were thin. Treatment was delayed in most cases because of the nonspecific presentation of the condition. The diagnosis of internal hernia should be borne in mind in patients who develop abdominal pain with persistent nausea or vomiting after operation, so that prompt treatment may be instituted.