J Korean Soc Radiol.  2018 Aug;79(2):88-91. 10.3348/jksr.2018.79.2.88.

Petersen's Hernia after Subtotal Gastrectomy with Billroth II Gastrojejunostomy for Gastric Cancer: A Specific CT Finding

• Kim H
• Chung YE
• Hyung WJ
• Lim JS

• KMID: 2416393
• DOI: http://doi.org/10.3348/jksr.2018.79.2.88

Abstract

Petersen's hernia is a rare internal hernia occurring after any type of gastrojejunal anastomosis. This type of internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction for obesity treatment has been reported frequently. However, reports about Petersen's hernia after gastrectomy with Billroth II gastrojejunostomy for gastric cancer are relatively rare. To diagnose internal hernia, whirl sign has been reported to be a sensitive predictor of internal hernia. However, it is hard to diagnose a specific type of internal hernia. We report a case of Petersen's hernia after radical subtotal gastrectomy with Billroth II gastrojejunostomy for gastric cancer with an unreported specific computed tomography finding that suggests Petersen's hernia.

MeSH Terms

Gastrectomy*
Gastric Bypass*
Gastroenterostomy*
Hernia*
Obesity
Stomach Neoplasms*
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Petersen's hernia in a 37-year-old woman. A. Abdominal contrast enhanced CT showing whirl sign which indicates mesenteric vessel rotation and mesenteric fat haziness (arrow). B. Abdominal contrast enhanced CT coronal image showing engorged vessels (arrow) and small bowel with diffuse dilatation without evidence of strangulation (arrowheads). C. Abdominal contrast enhanced CT showing small bowel (asterisk) interposed between the transverse colon (arrowheads) and the afferent limb (arrow) like a sandwich. D. A diagnostic laparoscopy showing internal herniation of the efferent limb (arrow) through the Petersen defect, a space between the transverse mesocolon (asterisk) and the afferent limb (arrowheads). E. The herniated small bowel was successfully reduced and the Petersen defect between the transverse mesocolon (asterisk) and the afferent limb (arrowheads) was closed using absorbable suture. CT = computed tomography

Reference

1. Rogers AM, Ionescu AM, Pauli EM, Meier AH, Shope TR, Haluck RS. When is a Petersen's hernia not a Petersen's hernia. J Am Coll Surg. 2008; 207:121–124.

2. Faria G, Preto J, Oliveira M, Pimenta T, Baptista M, Costa-Maia J. Petersen's space hernia: a rare but expanding diagnosis. Int J Surg Case Rep. 2011; 2:141–143.

3. Baba A, Yamazoe S, Dogru M, Okuyama Y, Mogami T, Kobashi Y, et al. Petersen hernia after open gastrectomy with Roux-en-Y reconstruction: a report of two cases and literature review. Springerplus. 2015; 4:753.

4. Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005; 19:34–39.

5. Somville FJ, De Moitié E, Fransen L. Atypical clinical presentation of internal herniation after laparoscopic Roux-en-Y gastric bypass. Acta Chir Belg. 2013; 113:152–154.

6. Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006; 16:1265–1271.

7. Ximenes MA, Baroni RH, Trindade RM, Racy MC, Tachibana A, Moron RA, et al. Petersen's hernia as a complication of bariatric surgery: CT findings. Abdom Imaging. 2011; 36:126–129.