Two Cases of Petersen's Hernia After Laparoscopic Total Gastrectomy

Abstract

We report two cases of Petersen's hernia occurring after a laparoscopy-assisted total gastrectomy (LATG). Case 1 was a 73-year-old man who had undergone an LATG for early gastric cancer 15 months prior to the development of a sudden abdominal pain. He was diagnosed as having an intestinal obstruction, and his severe condition necessitated emergency surgery. The intraoperative findings showed that almost all the small intestine had penetrated through a Petersen's defect (an unclosed meso-transverse orifice formed for the placement of the jejunum in a Roux-en-Y bypass), and torsion of the intestine was observed at the site, leading to the diagnosis of Petersen's hernia. The penetrating intestine was pulled out, and the Petersen's defect was closed with a suture. The patient recovered uneventfully and was discharged from hospital on postoperative day 7. Case 2 was a 68-year-old man who had undergone an LATG 24 months prior to the development of a severe abdominal pain and a visit to an outpatient clinic. The patient underwent an emergent celiotomy based on a diagnosis of strangulated ileus. The intraoperative findings showed a 1-m loop of the ileum impacted within a Petersen's defect and resulting in an intestinal obstruction (i.e., a Petersen's hernia). The involved intestine was pulled out, and the Petersen's defect was subsequently closed with a suture. The patient recovered uneventfully and was discharged on postoperative day 9.