A SIMPLE METHOD FOR THE DIAGNOSIS OF PETERSEN'S HERNIA COMPROMISING THE BILIOPANCREATIC LIMB.

Carlos Alberto Perim,Romeo Lages Simões,Marcelo Arimatéia Esteves Guedes,Políbio Guedes Ferreira Lopes,Marcus Flávio Carvalho E Carvalho

doi:10.1590/0102-672020180001e1429

Carlos Alberto Perim, Romeo Lages Simões + Show 3 more

Open Access

https://doi.org/10.1590/0102-672020180001e1429

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Abstract

The incidence of internal hernias in laparoscopic Roux-en-Y gastric bypass is 0.5-9.7% 2 , 7 . The diagnosis of intestinal obstruction should always be suspected in the presence of abdominal pain in patients previously submitted to it laparoscopically. Internal hernias are the main causes of intestinal obstruction after this surgical procedure 14 , and may occur through the mesenteric breach at the level of the enteroenteral anastomosis or the Petersen space, located between the transverse mesocolon and the mesentery of the alimentary loop elevated to the gastric pouch via antecolic and antegastric route. The most frequent intestinal obstruction, and also more severe, is that resulting from a Petersen hernia involving the biliopancreatic loop, because it has a closed loop. In Petersen hernia, the diagnosis can be difficult by a non-specific clinical picture of intestinal obstruction: acute and persistent chronic or intermittent abdominal pain, localized or diffuse; no nausea and vomiting; flatus can continue to be eliminated and the abdomen remains undisturbed 3 . Abdominal examination is usually not relevant. However, the early diagnosis of Petersen hernia is essential for the indication of an emergency operation, preventing severe and even fatal consequences 3 , 10 . The simple abdominal radiographic study is of little value, and computed tomography is the best imaging method to confirm the diagnosis. However, it fails in 20-30% of patients with Petersen hernia 7 . In addition, there is not always the availability of a CT scanner or qualified professional for the interpretation of the exam, and the surgeon remains uncertain and responsible to define what to do. Thinking about these difficulties we used a rather simple method, in an attempt to confirm the early diagnosis of the Petersen hernia involving the biliopancreatic loop. The method is based on normal anatomy, in which the jejunal loop closest to the duodenojejunal angle is always located to the left of the spine, and after laparoscopic gastric bypass, the only way the jejunal segment passes to the right side of the spine is through the space of Petersen.

Highlights

The incidence of internal hernias in laparoscopic Rouxen-Y gastric bypass is 0.5-9.7%2,7
The proposed method is based on normal anatomy, in which the jejunal loop near the duodenojejunal angle is always located to the left of the spine (Figure 2)
The only way this jejunal segment can passes to the right side of the spine is through the Petersen space

Summary

A SIMPLE METHOD FOR THE

Método simples para diagnosticar hérnia de Petersen comprometendo a alça biliopancreática diagnosis. It fails in 20-30% of patients with Petersen hernia[7]. There is not always the availability of a CT scanner or qualified professional for the interpretation of the exam, and the surgeon remains uncertain and responsible to define what to do. Thinking about these difficulties we used a rather simple method, in an attempt to confirm the early diagnosis of the Petersen hernia involving the biliopancreatic loop.

METHOD

INTRODUCTION

Findings

DISCUSSION