Makinodan Hiroki, Fujisawa Kentoku, Fukui Tatsuya, Haruta Shusuke, Ueno Masaki
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN.
Cureus. 2025 Jun 19;17(6):e86382. doi: 10.7759/cureus.86382. eCollection 2025 Jun.
Petersen hernia (PH) is a type of internal hernia in which a portion of the small intestine protrudes through a defect located between the small bowel limbs, transverse mesocolon, and retroperitoneum after any type of gastrojejunostomy. The laparoscopic approach facilitates the occurrence of this type of hernia owing to the lack of postoperative adhesions, which otherwise help prevent bowel motility and herniation. Closure of this anatomical space, formed between the jejunal mesentery, transverse mesocolon, and retroperitoneum, has been shown to significantly lower the incidence of hernia and associated complications such as bowel obstruction and strangulation. We report the case of a 41-year-old woman who underwent laparoscopic distal gastrectomy with a Roux-en-Y reconstruction and prophylactic closure of the Petersen's defect (PD) two years earlier for gastric cancer. She presented with abdominal pain and postprandial vomiting of three days' duration. Her abdomen was slightly distended, and tenderness was noted in the upper abdomen. Laboratory examination results were unremarkable. Contrast-enhanced CT revealed an internal hernia. Exploratory laparoscopy was performed, revealing a reopened Petersen space hernia of the common limb, with obstruction and dilatation of the biliary limb. The incarcerated bowel was repositioned, and there was no evidence of ischemia. The PD was closed using non-absorbable sutures. Awareness of this postoperative anatomical defect, including the possibility of its recurrence even when initially closed, is essential for appropriate management, given the nonspecific nature of its clinical and laboratory findings. Maintaining a low threshold for diagnosis and ensuring early surgical intervention are warranted to prevent serious complications related to bowel necrosis.
彼得森疝（PH）是一种内疝，在任何类型的胃空肠吻合术后，小肠的一部分通过位于小肠肠袢、横结肠系膜和腹膜后之间的缺损突出。由于缺乏术后粘连，腹腔镜手术方式促进了这种类型疝的发生，而术后粘连原本有助于防止肠道蠕动和疝形成。已证明封闭由空肠系膜、横结肠系膜和腹膜后之间形成的这个解剖间隙可显著降低疝及其相关并发症（如肠梗阻和绞窄）的发生率。我们报告一例41岁女性病例，该患者两年前因胃癌接受了腹腔镜远端胃切除术并进行Roux-en-Y重建及预防性封闭彼得森缺损（PD）。她出现了持续三天的腹痛和餐后呕吐。腹部稍膨隆，上腹部有压痛。实验室检查结果无异常。增强CT显示为内疝。进行了探查性腹腔镜检查，发现共同肠袢的彼得森间隙疝复发，胆胰支梗阻并扩张。嵌顿肠管复位，未发现缺血迹象。用不可吸收缝线封闭PD。鉴于其临床和实验室检查结果不具有特异性，认识到这种术后解剖缺陷，包括即使最初封闭仍有复发的可能性，对于恰当的处理至关重要。保持较低的诊断阈值并确保早期手术干预对于预防与肠坏死相关的严重并发症是必要的。
