Background : A rare occurrence of internal herniation through the ligament of Treitz after pancreaticoduodenectomy is described in this paper. A diagnosed case of a 62-year-old with ampullary adenocarcinoma underwent pylorus-preserving pancreaticoduodenectomy and was discharged well but was re-admitted 18 days post-op for symptoms of obstruction.

Methods : Initial work-up showed ileus vs partial gut obstruction. Conservative management failed and he was re-operated and underwent segmental resection and double-barrel ileostomy.

Results : Intraoperative findings showed dilated and edematous small bowels with a cut-off at the distal ileum strangulated at the ligament of Treitz. Almost all small bowels herniated through ligament of Treitz proximally with twisting of the edematous mesentery. Post-operative course was uneventful and was sent home improved.

Conclusions : Treitz hernia following pancreaticoduodenectomy is an unusual complication and is likely to be multifactorial, and the exact mechanisms involved may vary between individuals. Prompt diagnosis and intervention must be done to avoid adverse complications and consequences.