Abstract
The patient was an 81-year-old man with a history of total gastrectomy with Roux-en-Y reconstruction. He was transported to our hospital by ambulance complaining of severe upper abdominal pain. Abdominal computed tomography showed ascites with thickening of the small intestinal wall and increased mesenteric membrane lipid levels. Stenosis of the superior mesenteric artery was also observed. A 3D-reconstruction image showed volvulus, and emergency surgery was performed based on a diagnosis of small bowel volvulus. Accumulation of chylous ascites was noted when the abdomen was opened. It was a case of Petersen's hernia, where the small intestine had become impacted from left to right behind the dorsal jejunal loop. After the volvulus was corrected, since no signs of necrosis were noted, Petersen's defect was occluded, and the surgery was completed. The patient was discharged with much improvement on postoperative day 7. This case demonstrates that 3D-reconstruction of the superior mesenteric artery can be useful in diagnosing volvulus of the small bowel due to Petersen's hernia.
