Petersen hernia

Case contributed by Dr Bruno Di Muzio

Presentation

Patient in the late postoperative for bariatric surgery with complaints of recurrent abdominal pain.

Patient Data

Age: 35 years
Gender: Female
X-ray

Abdomen X-ray

Radiography of the abdomen shows abnormal distribution of intestinal gas; It seems that the middle-distal ileum courses downwards in the left hypochondrium.

CT

CT Abdomen and pelvis

It is possible to identify CT signs compatible with internal abdominal herniation suggesting Petersen hernia:

  • herniated intestinal loop segment above the gastric level
  • rotation of mesenteric vessels (whirl sign)
  • soft mesenteric fat haziness
  • ligament of Treitz displaced anteriorly and to the right and middle-distal ileum coursing downwards in the left hypochondrium

Case Discussion

Petersen hernia is a type of internal hernia which occurs in the potential space posterior to a gastrojejunostomy. In this specific type, the intestine moves into the potential space between the caudal surface of the transverse mesocolon and the edge of the Roux limb. Usually found in patients with a Roux-en-Y gastric bypass.

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Case information

rID: 14053
Published: 19th Jun 2011
Last edited: 29th Jun 2018
Inclusion in quiz mode: Excluded

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