Petersen hernia

Case contributed by Dr Bruno Di Muzio

Presentation

Patient in the late postoperative period 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. It is 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: 13th Aug 2019
Inclusion in quiz mode: Excluded

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