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British Journal of Healthcare and Medical Research - Vol. 10, No. 2
Publication Date: April 25, 2023
DOI:10.14738/jbemi.102.14094.
Yamileth, J. B., Adolfo, G. S. M., Mireya, D. L. F. G. Isabel, E. R. M., Israel, F. P. M., Antonio, G. D. E., Enrique, S. T., Antonio, D. L. B.,
& Sofía, H. M. M. (2023). Petersen's Hernia. Is it a Calculated Risk? British Journal of Healthcare and Medical Research, Vol - 10(2).
134-140.
Services for Science and Education – United Kingdom
Petersen's Hernia. Is it a Calculated Risk?
Jiménez Bonola Yamileth
General Surgeon, Surgical Department at “Dr. Rubén Leñero” General Hospital Secretary of
Health of Mexico City, National Autonomous University of Mexico, México City, México.
García Sánchez Morelos Adolfo
Colonic and Rectal Surgeon and General Surgeon, Surgical Department at “Dr. Rubén Leñero”
General Hospital Secretary of Health of Mexico City, National Autonomous University of
Mexico, México City.
De La Fuente González Mireya
General Surgeon, Surgical Department at “Dr. Gaudencio González Garza” General Hospital
Specialized Medical Unit, “La Raza”, National Medical Center, Mexican Social Security Institute,
National Autonomous University of Mexico, México City, México.
Estrada Rodríguez María Isabel
Podiatrist Pediatrician Department. Regional General Hospital No. 251, Metepec. Mexican
Social Security Institute. National Autonomous University of Mexico. México State, México.
Flores Pazos Mauricio Israel
General Surgeon, Surgical Department at “Dr. Rubén Leñero” General Hospital Secretary of
Health of Mexico City, National Autonomous University of Mexico, México City, México.
García Díaz Edson Antonio
General Surgeon, Surgical Department at “Dr. Rubén Leñero” General Hospital Secretary of
Health of Mexico City, National Autonomous University of Mexico, México City, México.
Shafler Tenorio Enrique
General Surgeon, Surgical Department at “Dr. Rubén Leñero” General Hospital Secretary of
Health of Mexico City, National Autonomous University of Mexico, México City, México.
De Luna Berrones Antonio
General Surgeon, Surgical Department at “Dr. Rubén Leñero” General Hospital Secretary of
Health of Mexico City, National Autonomous University of Mexico, México City, México.
Hernández Medina Myrna Sofía
General Surgeon, Surgical Department at “Dr. Rubén Leñero” General Hospital Secretary of
Health of Mexico City, National Autonomous University of Mexico, México City, México.
Abstract
Hernias as a pathological entity in Surgery are very frequent; while Petersen's
hernia is a complication acquired after abdominal surgery independently in any
type of digestive anastomosis. The objective is to report a case and carry out a
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Yamileth, J. B., Adolfo, G. S. M., Mireya, D. L. F. G. Isabel, E. R. M., Israel, F. P. M., Antonio, G. D. E., Enrique, S. T., Antonio, D. L. B., & Sofía, H. M.
M. (2023). Petersen's Hernia. Is it a Calculated Risk? British Journal of Healthcare and Medical Research, Vol - 10(2). 134-140.
URL: http://dx.doi.org/10.14738/jbemi.102.14094
review of the literature. A 47-year-old female with G III obesity, 4 years ago justified
bariatric surgery of the Roux-en-Y gastric bypass by laparoscopy, with data of
intestinal occlusion and acute abdomen. An emergency exploratory laparotomy
was performed, finding Petersen's internal hernia, with reduction without
complications with a satisfactory evolution. Petersen's hernia as a practically
exclusive complication of Bariatric Surgery has been increasing exponentially in
terms of its incidence in recent years, due to the reintroduction of the laparoscopic
approach. The difficulty of an early diagnosis causes catastrophic complications, so
a delay in the diagnosis, decision and surgical management, has devastating
consequences. In terms of surgery, it is a challenge for the medical professional that
requires exquisite preparation, character, iron and strict discipline. That is why an
omission, an error, a bad decision has catastrophic consequences. And an example
of this is Petersen's hernia, as an acquired pathology secondary to a calculated
omission or error by the surgeon in the surgical technique, more than costing
financial, human resources or the patient's life itself.
Keywords: Hernia. Petersen's hernia. Obesity. Bariatric Surgery.
INTRODUCTION
Hernias as a pathological entity in Surgery are very frequent and intestinal occlusion is one of
the most common complications thereof; this is not the case with internal hernias, which have
an incidence of less than 3% and their clinical manifestations are extremely rare, which is why
preoperative diagnosis is extremely difficult, which puts the expertise of clinicians and
surgeons to the test. [1] Petersen's hernia (PH) is a complication acquired after abdominal
surgery independently in any type of digestive anastomosis, but more frequent in any
gastrojejunostomy with an incidence of less than 0.6%, and which was first described by
Bundee in 1897. This space was later reaffirmed by the German surgeon Walther Petersen in
1900. [2]
OBJECTIVE
Report of a case and analysis of the literature.
CASE REPORTS
This is a 47-year-old female who attends the emergency department of the General Hospital
"Dr. Rubén Leñero" from the Ministry of Health of Mexico City, Mexico country. She denies
chronic-degenerative diseases. Surgical history of bilateral tubal occlusion 24 years ago and
normal delivery at 16 years. Weight prior to bariatric surgery of 118 kg and height of 1.63 m.
With a body mass index of 44.4 with grade III obesity, according to the classification of the
World Health Organization; [3] or EOSS 2 (Edmonton Obesity Staging System), [4] for which 4
years ago it justified performing bariatric Roux-en-Y gastric bypass surgery with laparoscopic
technique, undergoing an adequate evolution and fulfilling its objective, with a current weight
of 60 kg. It begins suddenly with diffuse abdominal pain, crampy, of low intensity, immediate
postprandial two hours after food intake, located in the epigastrium and mesogastrium, with a
gradual increase in intensity; becoming continuous and severe for 12 hours, and already in the
last 4 hours the symptoms become disabling. It presents with absence of evacuation and
without channeling gases in more than 18 hours, with nausea and occasional vomiting;
hyporexia, asthenia and adynamia. She denies fever. Physical examination with HR: 120x', FR:
28x', T/A: 98/62 mm Hg, Temp: 37.6°C. Conscious to drowsy, with dry mucous membranes,
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 2, April- 2023
Services for Science and Education – United Kingdom
pale integuments, abdomen with abdominal distension, peristalsis of struggle and metallic
sounds. Intense pain on abdominal palpation and increases exponentially on decompression,
making it impossible to palpate visceromegaly. Generalized tympanism. Capillary filling 6”.
Laboratories: minimum leukocytosis of: 11.3 x 10^3 mm3. Neutrophilia: 86.7%. Lymphopenia:
7.4%. With moderate microchromic microcytic anemia with hemoglobin: 9 mg/dl. Hematocrit:
28.5%. Platelets: 224.00 x 10^3 mm3. Prothrombin time: 13.1” INR: 1.14. Glucose: 93 mg/dl.
Urea: 26.8 mg/dl. Creatinine: 0.5 mg/dl Mild hypoalbuminemia of: 3.4. Hypocalcemia of: 7.7
mg/dl. With Ca corrected from: 8.18. C-reactive protein increased to: 7.97 mg/dl with a baseline
of 0.7. Na: 138 mEq/L. K: 3.54 Meq/L. LC: 110 mEq/L. Rest in normal parameters. Arterial blood
gases with ph: 7.43. PCO2: 32mmHg. PO2; 74mm Hg. HCO3: 22.8 nmol/L. Lac: 1 nmol/L. SO2c:
95%. BEecf: -3.1 nmol/L. X-rays of the abdomen standing and decubitus [Figure 1] with dilation
of the colon, air-fluid levels, edema of interest, reflex ileus, cut colon and fixed loop.
Figure 1
A simple abdominal computed tomography was performed, where interesting edema, intestinal
dilatation not equidistant or reciprocal, was visualized, with the whirlpool sign. [Figures 2, 3]
Figures 2 and 3