A special type of internal hernia – Roux-en-Y limb space internal hernia after gastrectomy: 6 case reports

Introduction and importance: The Roux-en-Y limb space internal hernia is a distinct and serious complication of Roux-en-Y anastomosis, with a higher incidence in laparoscopic procedures. It is difficult to diagnose and requires prompt surgical intervention. This study aimed to investigate the clinical and CT imaging characteristics of this condition. Case presentation: This study retrospectively analyzed patients from January 2015 to July 2025 who developed a surgically confirmed Roux-en-Y limb space internal hernia after Roux-en-Y anastomosis at our hospital. A comprehensive review of the six identified cases was performed, encompassing their clinical features, CT imaging, and surgical observations of intestinal perforation within the hernia. Clinical Discussion: The predominant clinical characteristics included abdominal pain, nausea, and vomiting. The abdominal pain was consistently colicky and localized to the right or central abdomen. CT imaging demonstrated findings of small bowel obstruction, twisting of the small bowel mesentery, ascites, and lacerations in the right or upper right abdominal region. Conclusion: The Roux-en-Y limb space internal hernia, a distinct form of internal hernia, typically presents as small bowel obstruction but poses diagnostic challenges. CT imaging is crucial for identification, and the presence of small bowel obstruction with a swirl sign and ascites on CT warrants early surgical intervention.