Mortality due to Internal Herniation As A Late Complication in A Patient who Underwent Laparoscopic Total Gastrectomy for Early Gastric Cancer

Potential spaces predisposing to internal hernias in the abdomen occurs after laparoscopic gastrectomy with Roux-en-Y reconstruction. Closure of potential spaces in primary surgery and early surgical treatment after herniation suspicion is important because of the high risk of morbidity and mortality. We hereby present the case of a patient who underwent laparoscopic total gastrectomy because of early-phase gastric cancer and who developed massive intestinal necrosis because of internal herniation in the third year of follow-up. A 60-year-old male underwent an urgent laparotomy, and ischemia in the cecum and all throughout the small intestine was observed because of small intestine herniation between the Roux limb and the meso of the transverse colon after laparoscopic gastrectomy for early gastric cancer. Following the detorsion of all the small intestinal segments, it was seen that the flow in the main branches of the superior mesenteric artery regained activity, but no significant change in coloring was achieved in the distal segments and the cecum. The patient, for whom relaparotomy was planned following stabilization, died in the fourth post-operative hour. The Roux-en-Y reconstruction performed after laparoscopic gastric resection leads to the formation of novel spaces in the abdomen. Internal herniation, which can lead to mortality, can be prevented by closing these spaces up. Moreover, it is significant to have early diagnosis and perform the necessary surgical procedure for treatment without delay.