Abstract
Petersen's space hernia: late complication of laparoscopic gastric bypass introduction: Petersen's Space Hernia is a protrusion of intestinal loops through a defect between the alimentary loop and the transverse mesocolon that occur as a late complication of Gastric Bypass. Objective: To present our experience in the management of this entity, making emphasis on the difficulty of clinical diagnosis, the typical CT Scan findings and to suggest prevention and management strategies. method: Case series study of patients with Petersen's Space Hernia after Laparoscopic Gastric Bypass. Clinical presentation, CT Scan findings and surgical results were analyzed. results: 8 patients. Mean age 43 years. All presented al least 12 months after primary surgery, with unspecific abdominal pain. CT Scan most frequent findings were: Swirled mesentery, engorgement of mesentery vessels and the mushroom sign. Surgery was performed lapa- roscopically in the 8 patients. no bowel ischemia was found. In all cases, once reduced the protruded loops, complete closure of the defect with a running non absorbable suture was done. conclusion: In patients with Gastric Bypass, presenting with abdominal pain, a high degree of suspicion must be kept about this entity. Clinical findings are unspecific and radiological study is crucial. When diagnosed on time bowel necrosis is avoided and the main surgical goal is to achieve a complete closure of the defect with non absorbable suture.
Highlights
Petersen’s Space Hernia is a protrusion of intestinal loops through a defect between the alimentary loop and the transverse mesocolon that occur as a late complication of Gastric Bypass
In patients with Gastric Bypass, presenting with abdominal pain, a high degree of suspicion must be kept about this entity
When diagnosed on time bowel necrosis is avoided and the main surgical goal is to achieve a complete closure of the defect with non absorbable suture
Summary
Introducción: La Hernia del Espacio de Petersen es una complicación tardía del bypass gástrico, que ocurre por la protrusión de asas intestinales a través del defecto que se genera entre el asa alimentaria y el mesocolon transverso. Método: Estudio de una serie de casos con diagnóstico de Hernia del Espacio de Petersen posterior a bypass gástrico. Conclusión: En los pacientes sometidos a bypass gástrico hay que mantener un alto grado de sospecha acerca de esta entidad. El objetivo de este estudio es presentar la experiencia de nuestro equipo en el manejo de esta patología, haciendo énfasis en la dificultad del diagnóstico clínico, los hallazgos más típicos de la TC y sugerir estrategias de prevención y manejo. Protocolo de manejo Para evitar la falla en el diagnóstico de esta entidad, se ha llevado a cabo un protocolo prospectivo de manejo, en que cualquier paciente portador de un bypass gástrico que se presenta con dolor abdominal inespecífico, pero sugerente de esta complicación
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