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Intestinal infarction by internal hernia in Petersen's space after laparoscopic gastric bypass

World Journal of Gastroenterology 2014年第43期20卷 16349-16354页

作者： Massimiliano Fabozzi riccardo brachet contul Paolo Millo Rosaldo Allieta General and Laparoscopic Surgery Department "Umberto Parini" Aosta Valley Regional Hospital11100 AostaItaly

Intestinal occlusion by internal hernia is not a rare complication(0.2%-5%)after Laparoscopic Roux-en-Y-GBP(LGBP)with higher morbidity and mortality related to mesenteric vessels *** our Center,from October 2009 to April 2013 we have had 17 pts treated for internal hernia on 412 LGBP(4.12%).Clinical case:28-year-old woman,operated of LGBP(BMI=49;comorbidity:diabetes mellitus and arthropathy)about 10mo before,was affected by recurrent abdominal pain with alvus alteration lasting for a *** vomiting,she went to first aid Unit of a peripheric hospital where she made blood tests,RX and US of abdomen that resulted normal so she was discharged with flu like syndrome *** 3 d the patient contacted our Center since her symptoms got worse and was *** tests showed an alteration of hepatic enzymes and *** abdominal computed tomography(CT)showed the presence of fluid in perisplenic,peri-hepatic areas and in pelvis and a"target like imagine"of"clustered ileal loops"with a superior mesenteric vein(SMV)thrombosis involving the Portal *** the operation,we found a necrosis of80 cm of ileus(about 50 cm downstream the jejuno-jejunal anastomosis)due to an internal hernia through Petersen’s space causing a SMV *** necrotic bowel was removed,the internal hernia was reduced and Petersen’space was sutured by not-absorbable running *** anticoagulant therapy was begun in the post-operative time and the patient was discharged after 28 ***:The internal hernia diagnosis is rarely confirmed by preoperative exams and it is obtained in most cases by laparoscopy but the improvement of technologies and the discover of"new"CT signs interpretation can address to an early laparoscopic treatment for high suspicion cases.

关键词： Intestinal infarction Internal hernia Petersen’s h

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