Petersen's Hernia after Esophagectomy With Antesternal Jejunal Reconstruction: Case Report

Kudo, Kenji; Narumiya, Kosuke; Shirai, Yuji; Yagawa, Yohsuke; Ota, Masaho; Yamamoto, Masakazu

doi:10.9738/intsurg-d-15-00296.1

Cited by 2 publications

(2 citation statements)

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“…Here we present the first reported cohort of patients with internal hernia and chylous ascites. The majority of cases within existing literature are associated with patent Petersen defect leading to chylous ascites [9,12,[14][15][16][17]. Similar to our findings, existing case reports highlight its benign nature as patients were discharged on postoperative day 2, and there are no reports of mortality in patients with internal hernia and chylous ascites.…”

Section: Discussionsupporting

confidence: 84%

Chylous ascites in the setting of internal hernia: a reassuring sign

et al. 2021

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Background Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. MethodsData from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. ResultsFifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP).Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p<0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p<0.001).Conclusions Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect.

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Section: Discussionsupporting

confidence: 84%

Chylous ascites in the setting of internal hernia: a reassuring sign

et al. 2021

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“…There have been a number of articles learning the incidence, clinical manifestation, and outcome of Petersen's hernia. However, most of them are single-case descriptions or case series reports (7)(8)(9)(10). The low incidence of Petersen's hernia hampers large prospective investigation.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

Liu

Song

et al. 2021

Front. Oncol.

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BackgroundPetersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions.MethodsData from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation.ResultsA total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p < 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041).ConclusionsLow BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.

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Petersen's Hernia after Esophagectomy With Antesternal Jejunal Reconstruction: Case Report

Cited by 2 publications

References 9 publications

Chylous ascites in the setting of internal hernia: a reassuring sign

Chylous ascites in the setting of internal hernia: a reassuring sign

Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

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