Intestinal infarction by internal hernia in Petersen’s space after laparoscopic gastric bypass

Fabozzi, Massimiliano; Contul, Riccardo Brachet; Millo, Paolo; Allieta, Rosaldo

doi:10.3748/wjg.v20.i43.16349

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…However, IH at the intermesenteric defect may be very dangerous due to the small size of the orifice. The herniation of the small bowel in mesenteric orifices created by the RYGB procedure may have severe consequences, including small bowel obstruction, ischemia, necrosis, and perforation if the diagnosis and treatment are not prompt [ 6 ]. It is mandatory to close the Petersen’s and intermesenteric orifices during RYGB to reduce the incidence of IH.…”

Section: Introductionmentioning

confidence: 99%

Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm

et al. 2021

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Background Internal hernia (IH) represents a relatively common and well-known complication after Roux-en-Y gastric bypass. IH after one anastomosis gastric bypass (OAGB) is less frequent and rarely reported in the literature. This study presents a series of IH after OAGB observed in a high-volume bariatric center. Methods Data of patients who underwent OAGB with an afferent limb of 150 cm between May 2010 and September 2019 were prospectively collected and retrospectively analyzed. Data of patients undergoing surgery for IH during follow-up were collected and analyzed. Results Ninety-six patients out of 3368 with a history of OAGB had intestinal incarceration in the Petersen’s orifice (2.8%). Specificity and sensitivity of computed tomography scans in the diagnosis of IH were 59% and 76%, respectively. The mean timeframe between OAGB and surgery for IH was 21.9±18.3 months. Mean body mass index at the time of IH surgery was 24.7 ± 3.6. Surgery was completed laparoscopically in 96.8% of cases. Nine patients (9.3%) had signs of bowel hypovascularization. In all patients, the herniated bowel was repositioned, and the Petersen’s orifice was closed, without the need for bowel resection. Mean hospital stay was 1.9 ± 4.8 days. The postoperative morbidity rate was 8.3%. Long-term IH relapse was observed in 14 patients; signs of bowel hypovascularization due to incarceration in a small orifice was observed in eight of these patients (57%). Conclusions Incidence of IH after OAGB is 2.8%. IH is associated with a low rate of bowel ischemia and the need for intestinal resection.

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Section: Introductionmentioning

confidence: 99%

Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm

et al. 2021

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“…There is a current consensus that all mesenteric spaces should be closed in laparoscopic Roux-en-Y gastric bypass, which reduces the incidence of internal hernias 15 . However, in many patients Petersen’s closure of the space is not or is not yet done, due to the greater technical difficulty.…”

Section: Discussionmentioning

confidence: 99%

A Simple Method for the Diagnosis of Petersen’s Hernia Compromising the Biliopancreatic Limb

Perim¹,

Guedes²,

Carvalho³

et al. 2019

ABCD, arq. bras. cir. dig.

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“…Internal hernias in this space are a fairly common postoperative complication, with a reported incidence of 1.2%–2.3% after gastrectomy with Roux-en-Y reconstruction for gastric cancer[ 5 , 6 ]. This surgical complication causes disastrous sequelae, such as massive intestinal necrosis, fatal Roux limb necrosis, and superior mesenteric vein (SMV) thrombus[ 7 ]. Protein-losing enteropathy (PLE) is a rare syndrome characterized by a loss of serum protein in the gastrointestinal tract.…”

Section: Introductionmentioning

confidence: 99%

Protein-losing enteropathy caused by a jejunal ulcer after an internal hernia in Petersen's space: A case report

Yasuda¹,

Sakurazawa²,

Kuge³

et al. 2022

WJCC

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BACKGROUND The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery. Of particular concern are internal hernias occurring in Petersen's space, a space that is surgically created after treatment for gastric cancer and obesity. These hernias cause devastating sequelae, such as massive intestinal necrosis, fatal Roux limb necrosis, and superior mesenteric vein thrombus. In addition, protein-losing enteropathy (PLE) is a rare syndrome involving gastrointestinal protein loss, although its relationship with internal Petersen’s hernias remains unknown. CASE SUMMARY A 75-year-old man with a history of laparotomy for early gastric cancer developed Petersen's hernia 1 year and 5 mo after surgery. He was successfully treated by reducing the incarcerated small intestine and closure of Petersen’s defect without resection of the small intestine. Approximately 3 mo after his surgery for Petersen’s hernia, he developed bilateral leg edema and hypoalbuminemia. He was diagnosed with PLE with an alpha-1 antitrypsin clearance of 733 mL/24 h. Double-balloon enteroscopy revealed extensive jejunal ulceration as the etiology, and it facilitated minimum bowel resection. Pathological analysis showed extensive jejunal ulceration and collagen hyperplasia with nonspecific inflammation of all layers without lymphangiectasia, lymphoma, or vascular abnormalities. His postoperative course was unremarkable, and his bilateral leg edema and hypoalbuminemia improved after 1 mo. There was no relapse over the 5-year follow-up period. CONCLUSION PLE and extensive jejunal ulceration may occur after Petersen's hernia. Double-balloon enteroscopy helps identify and resect these lesions.

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Intestinal infarction by internal hernia in Petersen’s space after laparoscopic gastric bypass

Abstract: The internal hernia diagnosis is rarely confirmed by preoperative exams and it is obtained in most cases by laparoscopy but the improvement of technologies and the discover of "new" CT signs interpretation can address to an early laparoscopic treatment for high suspicion cases.

Cited by 10 publications

References 15 publications

Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm

Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm

A Simple Method for the Diagnosis of Petersen’s Hernia Compromising the Biliopancreatic Limb

Protein-losing enteropathy caused by a jejunal ulcer after an internal hernia in Petersen's space: A case report

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