Petersen's Hernia After Roux-en-Y Gastric Bypass: A Case Report

Abstract

Internal hernia (IH) is the protrusion of abdominal contents, mostly small bowel loops, through a defect in the peritoneum or mesentery. Petersen's hernia is a type of internal hernia, in which part of the intestinal loop protrudes through a defect between small bowel limbs, transverse mesocolon, and retroperitoneum. It has been reported in individuals undergoing gastrojejunostomy (GJ), especially following bariatric surgeries. Because of the expanding popularity of these surgical treatments, the total incidence of internal hernias has recently increased. The laparoscopic Roux-en-Y gastric bypass (RYGB) has been proven to be a safe and successful alternative to the classic open RYGB. Although the absence of postoperative adhesions is one advantage of minimally invasive surgery, it facilitates the occurrence of internal hernia with reported rates of 5% three months to three years following surgery. Clinical findings are vague and can vary from mild to severe abdominal pain that can be accompanied by vomiting, nausea, and abdominal distention.

Keywords: bariatric surgery; bowel obstruction; internal hernia; peterson’s hernia; roux-en-y gastric bypass.

Figure 1. CT abdomen with contrast (coronal view)

Showing signs of small bowel obstruction due to improper filling of the contrast, marked dilatation of parts of the small bowel surrounded by effusion

Figure 2. CT abdomen with contrast (axial view)

showing the difference between (A) the proximal dilated part of the small intestine and (B) the distal collapsed slightly enhanced part (indicating signs of ischemia)

Figure 3. Intraoperative laparoscopic view

Showing part of the jejunum protruding through Petersen's defect