Any gastric operation resulting in gastrojejunostomy produces a potential internal hernia ring which may be lethal in the immediate or remote postoperative period. It is the purpose of this paper to report two nonfatal cases, to alert the clinician to this possibility, and to remind the surgeon that this ring may be easily and expeditiously eliminated at the time of the original operation.
Report of Cases
Case 1, a 75-year-old female, was admitted because of recurrent abdominal pain and distention with nausea and vomiting. Each episode lasted for a few hours and subsided spontaneously. One episode required hospitalization but subsided shortly after admission. The patient had a partial gastrectomy and posterior gastrojejunostomy two years previously for upper gastrointestinal hemorrhage.Physical examination revealed a moderately distended abdomen with visible peristalsis. There was generalized tympany. Bowel sounds were normal and there was an epigastric mass. Tenderness was primarily in the left upper