Presentation
History of Roux-en-Y gastric bypass surgery 5 years ago and laparoscopic repair of Peterson defect 2 years ago was referred because of intermittent crampy abdominal pain and nausea for one month
Patient Data
Biliopancreatic limb crosses the midline to the right side through Peterson space, below the transverse mesocolon. The ligament of Treitz is displaced anteriorly. whirl sign is evident in mesenteric vessels.
Case Discussion
Petersen's space internal hernia is caused by herniation of intestinal loops posterior to a gastrojejunostomy through a defect between the small bowel limbs, transverse mesocolon, and retroperitoneum. Common symptoms are nausea and abdominal pain that sometimes could be intermittent due to recurrent herniation (as was thought to be the case in this patient).
As in this patient, the Petersen hernia may sometimes recur.
The diagnosis was confirmed during surgery and the Petersen defect was repaired.
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