World Journal of Laparoscopic Surgery

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VOLUME 17 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Perforated Strangulated Roux Limb in Diaphragmatic Hernia—A Rare Complication after Laparoscopic Total Gastrectomy for Gastric Cancer: A Case Report

Georgia Roberts, Michael Bozin, Bruce D Wilkie, Phil Chan, Cuong Duong

Keywords : Case report, Diaphragmatic hernia, Gastric cancer, Laparoscopic gastrectomy

Citation Information : Roberts G, Bozin M, Wilkie BD, Chan P, Duong C. Perforated Strangulated Roux Limb in Diaphragmatic Hernia—A Rare Complication after Laparoscopic Total Gastrectomy for Gastric Cancer: A Case Report. World J Lap Surg 2024; 17 (1):55-57.

DOI: 10.5005/jp-journals-10033-1570

License: CC BY-NC 4.0

Published Online: 14-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: To report a case of a perforated strangulated roux limb in diaphragmatic hernia as a rare complication following laparoscopic total gastrectomy for gastric cancer. Background: As minimally invasive surgery (MIS) becomes increasingly performed for esophagogastric cancers, diaphragmatic hernias (DHs) pose new challenges for surgeons. Case description: We report the case of a 59-year-old patient who presented with hematemesis, epigastric pain, and hemodynamic instability. The patient had a history of gastric adenocarcinoma and had undergone a laparoscopic total gastrectomy 3 years before. The computed tomographic scan demonstrated a diaphragmatic hernia with a strangulated and perforated roux limb. The patient underwent staged resection of the necrotic roux limb to manage sepsis, followed by restoration of alimentary continuity. Conclusion: A diaphragmatic hernia (DH) is a challenging complication of MIS for esophagogastric cancers and may be difficult to prevent. A staged approach was invaluable, allowing for careful assessment, expert opinion, and reconstruction. Clinical significance: As MIS becomes increasingly performed, cases of complicated DH may become more apparent. Preventing DH may be difficult. A sutured crural repair with or without pexy of the roux limb may be performed if DH is identified at the time of gastrectomy. The value of mesh is unclear, and erosion remains a main concern.

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