Chinese Medical Journal

a Si

8 Chinese Medical Journal, 74: 69-74, January-February, 1956:

INTESTINAL OBSTRUCTION DUE TO INTERNAL HERNIA FOLLOWING PARTIAL GASTRECTOMY

Hst' Cul-Ho (/2 #e), HU CHI-JUNG (40 42)AND HSU CHIH-MING (4 445A) Department of Surgery, Shanghai Municipal First Labor Hospital, Shanghai

Partial gastrectomy, a procedure widely used. today, can be accomplished with a very low mortality. In seeking to further improve the safety of a dependable procedure one’s attention is naturally directed towards the treatment and prevention of serious though rare complications that may arise. The present communication consists of a report of 2 cases of intestinal obstruction due to internal herniation of the proximal jejunal loop following partial gastrectomy and antecolic gastrojejunostomy. The report is made because due attention is not always paid to this rare but serious complication.

Between May 1951 and November 1954, 101 partial gastrectomies were done in this hospital, 98 for peptic ulcers (38 duodenal and 60 gastric ulcers) and 3 for gastric malignancies. All of them were resections of two thirds to three fourths of the stomach followed by gastrojejunal anastomoses of one type or another. In 97 instances the gastrojejunostomies were of the antecolic type with the proximal end of the jejunal loop sutured to the lesser curvature of the stomach and the entire cut end of the stomach used for the stoma (Balfour). In 1 instance, antecolic anastomosis was done by suturing the proximal end of the jejunal loop to the greater curvature of the stomach (Moynihan). In 3 instances, retrocolic gastrojejunostomies were done with the proximal end of the jejunal loop sutured to the lesser curvature of the stomach (Polya). The 2 cases of intestinal obstruction due to internal hernia occurred among the 97 cases of the Balfour type of antecolic gastrojejunostomies. Because of timely diagnosis and surgical intervention, the patients in both these cases recovered. They were found well and in good health three and a half and two and a half years later.

REPORT OF CASES

Case 1. Chen, a 43 year old house wife, was first admitted to this hospital on November 15, 1951 for gastric ulcer of about ten years duration. The clinical diagnosis of gastric ulcer was substantiated by x-ray studies with barium meal. She was operated upon under ether anesthesia on November 28, 1951. A partial gastrectomy removing the pylorus and three fourths of the stomach was performed followed by an antecolic gastrojejunostomy, the proximal end of the jejunal loop being sutured to the lesser curvature of the stomach, and the entire cut end of the stomach