Incarcerated hiatal hernia with afferent loop syndrome after laparoscopic total gastrectomy with Roux-en-Y...

Hiatal hernia is one of the rarest types of internal herniation that can occur after gastrectomy. We present a case of hiatal hernia accompanied with afferent loop syndrome.

An 82-year-old male, who had undergone laparoscopic total gastrectomy and D2 lymphadenectomy with Roux-en-Y reconstruction 10 months prior was admitted to the emergency room with acute abdominal pain.

A computed tomography revealed a hiatal hernia containing efferent and left-sided small bowel loops, dilation of the afferent limb, and dilation of the extrahepatic biliary duct due to afferent limb obstruction.

Laparoscopic reduction was significantly hindered by bowel edema. To ease the reduction of the small bowel, an incision was made to the diaphragm to ensure a bigger hiatal opening. After the reduction was complete, the hiatal opening was sutured to reduce the size of the diaphragmatic hiatus.

Reduced small bowels were in viable condition. The patient was discharged eleven days after surgery without any complications.

The case demonstrates that hiatal hernia with afferent loop syndrome can occur after total gastrectomy with Roux-en-Y reconstruction. And, in such cases, incision of the diaphragm may be necessary for a safer bowel reduction.