AB026. PP-5 Petersen hernia—a rare cause of acute abdomen after laparoscopic gastric by-pass operation

Abstract: Petersen’s hernia is a rare type of internal herniation and it has been reported in the literature after Laparoscopic Roux-en-Y gastric bypass (LGB) which is one of the most common bariatric surgical methods. A 27-year-old female patient with a history of LGB operation 2 years ago at the outpatient clinic for obesity presented to the emergency department with complaints of abdominal pain, nausea and vomiting persisting for two days. On her physical examination, there was tenderness, with defense and rebound markedly in the upper left quadrant of abdomen. Laboratory tests were unremarkable except for leukocytosis. Abdominal X-ray showed air fluid levels. Abdomen computerized tomography (CT) was compatible with mechanic bowel obstruction. Explorative laparotomy was performed due to signs of acute abdomen and mechanic bowel obstruction. During laparotomy, it was observed that the small intestines herniated into the space between Roux leg and transverse colon mesocolon which called as “Petersen hernia”. After reducing the incarcerated small intestines without resection, hernia defect was repaired by non-absorbable suture material. Postoperative follow-up period was unremarkable. The patient was discharged postoperative fifth day without any complication. Internal herniation often presents with non-specific findings. It does not show any clinical findings unless strangulation or incarceration occurs. It is a rare clinical condition that may occur in the early postoperative period and may occur many years later. It has been reported in the literature that the incidence of internal herniation is increased in patients who underwent LGB, which is one of the bariatric surgery methods. These patients often present to the emergency department with non-specific complaints such as abdominal pain, nausea and vomiting. Abdomen CT with oral and intravenous contrast is important in the diagnosis of the disease. Thickening of intestinal loops, dilated bowel loops, target sign and abnormal clustering of intestinal loops may be helpful in diagnosis. Petersen hernia should be kept in mind in patients with a history of bariatric surgery presenting with abdominal pain Delays in diagnosis can result in incarceration or strangulation with high mortality and morbidity. In conclusion, closure of meso openings during LGB operations reduces the formation of Petersen hernia that may develop in early and late postoperative periods. It will reduce the mortality and morbidity secondary to Petersen hernia.

Keywords: Laparoscopic gastric bypass; ileus; Petersen hernia; acute abdomen