부산대학교 도서관

A 72-year-old obese woman (the height 150cm, the weight 88 kg and the BMI 39.1) who had gone to a primary care doctor to treat diabetes mellitus and hypertension underwent distal gastrectomy and Billroth-I reconstruction for gastric cancer in our hospital. Her postoperative course was uneventful and she was discharged on the 10th postoperative day. Thereafter adjuvant chemotherapy with oral intake of S-1 was started at the 28th postoperative day. She came to our emergency room for acute abdominal pain after coughing on the 31st postoperative day. Abdominal CT scan showed an abdominal incisional hernia, fluid collection, and free air. We diagnosed the case as incisional hernia and rupture of the small intestine and performed operation. Laparotomy disclosed that a small intestine adhered to the hernia hilum had ruptured by three-fourths of the circumference of the bowel. Partial resection of the small intestine was performed. We etiologically estimated the cause of the bowel rupture in our case as follows. Sudden elevation of abdominal pressure by coughing behind the host's obesity formed the abdominal incisional hernia, when the small bowel which adhered to the hernia hilum ruptured simultaneously. As there have been no such reported cases, our case is considered very rare.