Bowel obstruction secondary to internal hernia after laparoscopic Nissen fundoplication and gastrostomy tube placement

Fundoplication is a commonly performed procedure in infants and children with the diagnosis of gastroesophageal reflux disease. Complications after fundoplication still exist and occur more frequently in children, particularly infants less than 4 months of age and those with esophageal atresia.5 Reported complications range from 0.5 to 11.5 per cent and include disruption of the wrap, dysphagia due to an excessively tight wrap, herniation of the wrap into the posterior mediastinum due to disruption of the crural repair, and adhesive intestinal obstruction.5-8 The complication of intestinal obstruction secondary to an internal hernia is rare, accounting for less than 2 per cent of all cases of intestinal obstruction.9· 10 In the adult literature, two cases of internal hernia after laparoscopic Nissen fundoplication are described: a 62-year-old after laparoscopic Nissen fundoplication with obstruction secondary to jejunum herniating through a defect in the falciform ligament11 and a 51 -year-old after laparoscopic Nissen fundoplication with obstruction secondary to cecal herniation through the foramen of Winslow.12 This is the first reported case of an internal hernia in a pediatric patient after laparoscopic Nissen fundoplication and gastrostomy tube placement.