Petersen hernia

Case contributed by Bruno Di Muzio
Diagnosis probable

Presentation

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

Patient Data

Age: 35 years
Gender: Female

Abdomen X-ray

x-ray
Frontal
Frontal
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Info

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

CT Abdomen and pelvis

ct
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal renal
excretory phase
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Info

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. It is usually found in patients with a Roux-en-Y gastric bypass.

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