Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Mar 8;16(3):e55815.
doi: 10.7759/cureus.55815. eCollection 2024 Mar.

Petersen's Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment

Citlali Calderón Espinosa de Los Monteros  1 , Agustin Castro Segovia  1 , Steve Arciniega Belmont  1
Affiliations
Case Reports

Petersen's Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment

Citlali Calderón Espinosa de Los Monteros et al. Cureus. .

Abstract

Roux-en-Y gastric bypass (RYGB) patients are at risk of creating potential spaces for possible internal hernias during the procedure. During pregnancy, the pregnant uterus elevates the bowel, increasing intra-abdominal pressure. Cases reported to date have described mild abdominal pain and no evidence of peritoneal irritation, with inconclusive ultrasound and MRI findings for diagnosis of Petersen's hernia. We present the case of a 42-year-old female patient with a history of RYGB eight years earlier without complications, with a pregnancy of 34 weeks of gestation. Symptomatology began with colicky abdominal pain in the epigastric, with irradiation to the right upper quadrant. On physical examination, revealed a painful abdomen on the median and deep palpation in the epigastric and right upper quadrant, the rest of the studies were inconclusive. As there was no improvement of the symptoms in 12 hours, an emergency diagnostic laparoscopy was performed, finding a strangulated Petersen's hernia requiring resection, with the closure of the gastric pouch, intestinal anastomosis, and Stamm gastrostomy with closure of the mesenteric gap. Therefore, a pregnant patient presenting with upper quadrant abdominal pain with a history of RYGB, even one with normal labs and imaging, should be assumed to have an internal hernia until proven otherwise. The emergency surgical approach is associated with early resolution and prevents its progression with catastrophic results.

Keywords: emergency exploratory laparotomy; mesenteric internal hernia; petersen's hernia; pregnant woman; roux-en-y gastric bypass (rygb).

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The figure shows intestinal necrosis of all Roux-en-Y loops secondary to strangulated Petersen's hernia, containing 110 cm of the alimentary limb, 10 cm of the biliopancreatic limb, and 10 cm of the common limb.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Pregnancy after bariatric surgery and adverse perinatal outcomes: a systematic review and meta-analysis. Akhter Z, Rankin J, Ceulemans D, et al. PLoS Med. 2019;6:1002866. - PMC - PubMed
    1. Fertility, pregnancy and post partum management after bariatric surgery: a narrative review. Cheah S, Gao Y, Mo S, et al. Med J Aust. 2022;7:96–102. - PMC - PubMed
    1. Pregnant patient with acute abdominal pain and previous bariatric surgery. Leclercq WK, Uittenbogaart M, Niemarkt HJ, van Laar JO. BMJ Case Rep. 2019;12:228962. - PMC - PubMed
    1. Pregnancy after bariatric surgery. Fisher SA, Stetson BT, Kominiarek MA. JAMA. 2023;329:758–759. - PubMed
    1. Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis. Apostolou KG, Lazaridis II, Kanavidis P, et al. Langenbecks Arch Surg. 2023;408:49. - PubMed

Publication types

LinkOut - more resources

  NODES
INTERN 6
twitter 2