Abstract
Petersen's hernia is an internal hernia that is peculiar to the patient who underwent gastrectomy with Roux-en-Y reconstruction. It develops when the small intestine herniates through the Petersen's defect, a mesenteric defect of the transverse mesocolon. It is likely to be caused by laparoscopic surgery because of fewer adhesions than celiotomy. Between January 2008 and December 2011, we experienced six cases (five patients) of the disease. All the patients underwent laparoscopy-assisted distal gastrectomy with Roux-en-Y reconstruction. In all the cases, abdominal computed tomography showed dilatation of a part of the small intestine involving periphery of the superior mesenteric artery (whirl sign), causing obstruction. We performed repair of the internal hernia, strangulation of the ileus, and suture of the Petersen's defect to prevent relapse of the disease. All the patients did not show obvious bowel necrosis. Their postoperative courses were uneventful, and all the patients were discharged.
Now in our hospital we suture the Petersen's defect preventively at Roux-en-Y reconstruction, and the patients treated by the suture have not developed the disease to date. As laparoscopic gastrectomy has increasingly been performed, Petersen's hernia is expected to increase. It is important to conduct abdominal CT scanning as early as possible from the clinical history and physical findings, and to determine the surgical indication.
