Incidence and risk factors of symptomatic Petersen’s hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis

Αποστόλου, Κωνσταντίνος; Lazaridis, Ioannis; Kanavidis, Prodromos; Triantafyllou, Margarita; Gkiala, Anastasia; Alexandrou, Andreas; Ntourakis, Dimitrios; Delko, Tarik; Schizas, Dimitrios

doi:10.1007/s00423-023-02798-4

Cited by 5 publications

(10 citation statements)

References 46 publications

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“…In 1900, Petersen described the space created between the transverse mesocolon, the Roux branch, and the retroperitoneum dorsally. PH is created iatrogenically after each type of gastrojejunostomy [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the meta-analysis by Apostolou et al [ 5 ], they report an overall incidence of PH of up to 14.3% regardless of pregnancy, mentioning that there is a bias in its true incidence, since not all cases are reported, but mainly asymptomatic cases with incidental findings [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pregnancy and rapid weight loss within the first year after bariatric surgery are associated with higher rates of preterm delivery, delivery of a small-for-gestational-age newborn, and admission to the neonatal intensive care unit compared to pregnancies more than two years after bariatric surgery [ 4 ]. This weight loss occurs with greater speed during the first year [ 5 ], so in the clinical case presented, the main risk factor was the increase in intra-abdominal pressure, since the RYGB was performed eight years before pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical picture of PH varies widely, from asymptomatic, mild, intermittent abdominal pain to presenting with evidence of peritoneal irritation secondary to acute small bowel obstruction, which may result in strangulation with intestinal necrosis, requiring an emergency exploratory laparotomy [ 5 , 2 ]. Dave et al [ 7 ], in a systematic review of 59 pregnant patients with a history of RYGB and a diagnosis of internal hernia, found that the most common presenting symptom was epigastric pain with nausea and vomiting [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Apostolou et al [ 5 ] state that reported cases of PH after RYGB in a pregnant patient at present have been found with mild abdominal pain and no peritoneal irritation which, when complemented with ultrasound or magnetic resonance imaging (MRI), do not conclude the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Petersen’s Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment

Calderón Espinosa de los Monteros,

Castro Segovia,

Arciniega Belmont

2024

Cureus

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Roux-en-Y gastric bypass (RYGB) patients are at risk of creating potential spaces for possible internal hernias during the procedure. During pregnancy, the pregnant uterus elevates the bowel, increasing intra-abdominal pressure. Cases reported to date have described mild abdominal pain and no evidence of peritoneal irritation, with inconclusive ultrasound and MRI findings for diagnosis of Petersen's hernia. We present the case of a 42-year-old female patient with a history of RYGB eight years earlier without complications, with a pregnancy of 34 weeks of gestation. Symptomatology began with colicky abdominal pain in the epigastric, with irradiation to the right upper quadrant. On physical examination, revealed a painful abdomen on the median and deep palpation in the epigastric and right upper quadrant, the rest of the studies were inconclusive. As there was no improvement of the symptoms in 12 hours, an emergency diagnostic laparoscopy was performed, finding a strangulated Petersen's hernia requiring resection, with the closure of the gastric pouch, intestinal anastomosis, and Stamm gastrostomy with closure of the mesenteric gap. Therefore, a pregnant patient presenting with upper quadrant abdominal pain with a history of RYGB, even one with normal labs and imaging, should be assumed to have an internal hernia until proven otherwise. The emergency surgical approach is associated with early resolution and prevents its progression with catastrophic results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%