A Rare Cause of Ileus: Petersen Hernia

Petersen hernia is a rare specific kind of internal hernia formed by intestinal migration to the space between anastomotic limb of gastrojejunostomy and transverse mesocolon. In the past, this hernia had been reported in subtotal gastrectomy performed for peptic ulcer or gastric cancer; now, its prevalence has increased in Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion surgeries. In this case report, we aimed to present a case of Petersen hernia developed at 20 year after distal gastrectomy RYGB anastomosis performed for peptic ulcer. Radiological reports of the patient applied to the emergency room for abdominal pain and vomiting suggested a pre-diagnosis for ileus and internal herniation; laparotomy was performed, showing the signs of distal gastrectomy and RYGB. Proceeding to exploration, intestinal hernia (Petersen Space) was detected in the space between rou limb and transverse mesocolon, and without resection, the hernia was reducted and defect was fixed. Although surgeries of ulcer has been receded recently, surgeries of obesity has been performed in increasing rates and internal herniation dependent on RYGB surgery gained importance in the literature. Healing these potential defects by various methods in laparoscopic or open surgery helps to decrease the postoperative complication rates