[Strangulation Ileus Caused by Incarcerated Esophageal Hiatal Hernia after Laparoscopic Total Gastrectomy - A Case Report].

Laparoscopic total gastrectomy(LTG)is one of the most increasing surgeries among gastric cancer surgery. Although LTG has many advantages on the patient, we should be more careful of its specific complications. Here we report a case of 72- year-old man with the complaint of severe acute upper abdominal pain due to strangulation ileus caused by incarcerated esophageal hiatal hernia(EHH)after LTG. Emergent operation has performed on the patient and total 180 cm length of necrotic small intestine was resected. EHH after gastrectomy was thought to be rare complication. However, some literature reported that EHH after gastrectomy, especially after LTG has more possibility than it has ever thought to be. Laparoscopic surgery has more advantages than open surgery in terms of less invasiveness, rapid postoperative recovery, and less intraabdominal adhesion. One of the causes for EHH after LTG is ironically thought to be its less intraabdominal adhesion. We concluded that crus repair is one of the effective methods for the prevention of EHH after LTG through experiencing this case.

Intraperitoneal rupture of the ureter as a cause of generalized peritonitis: report of a case.

We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.