Petersens Hernia

Petersen's Hernia After Roux-en-y Gastric Bypass

Petersen’s internal hernia occurs posterior to a gastroenteric anastomosis. Although rare, this hernia was well known during the 75 years in which chronic peptic ulcer disease was commonly treated by gastric resection and gastrojejunostomy. Since elective surgery for chronic peptic ulcer disease is now uncommon, a whole generation of surgeons may not be familiar with Petersen’s hernia at a time when this defect is making a resurgence because of the increasing popularity of Roux-en-Y gastric bypass to treat morbid obesity. Early recognition of this potentially serious condition is essential.

In the undisturbed abdominal cavity, the transverse colon acts as a partition between the stomach above and the small intestine below. Once a gastroenteric anastomosis is constructed, a potential space for internal herniation is created posterior to the limbs of the small intestine. The risk for herniation exists whether the anastomosis is ante- or retrocolic and whether the gastrojejunostomy is nonresectional or performed after a partial or subtotal gastrectomy.