Internal Hernia into the Treitz Fossa after Pancreaticoduodenectomy

The development of an internal hernia into the Treitz fossa after pancreaticoduodenectomy has not been previously reported. We herein present such a case with a brief review of the literature. A 43-year-old man who had undergone pancreaticoduodenectomy with reconstruction of the digestive tract by the Child method at our hospital 7 months previously presented with abdominal pain. Computed tomography showed intestinal ileus with formation of a small intestinal loop that was suspected to be an internal hernia. Intraoperatively, we found that the dilated small intestine had entered the upper side of the abdomen from the ligament of Treitz. We detached the intestine from the hernia and placed it in its normal position. The ligament of Treitz at the hernia orifice was closed with sutures. The patient remained in good health and was discharged from the hospital 18 days after the second operation. Suturing of the Treitz fossa at the time of pancreaticoduodenectomy may be important to prevent the formation of an internal hernia.