title: Petersen's space hernia: A rare but expanding diagnosis.
abstract: BACKGROUND
  Petersen's space hernia is caused by the herniation of intestinal loops through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum, after any type of gastrojejunostomy. The laparoscopic approach facilitates the occurrence of this type of hernia, due to the lack of post-operative adhesions which prevent bowel motility and hence, herniation.
  
  
  METHODS
  We report the case of a 46 year-old male submitted to an open antrectomy and vagotomy with a Roux-en-Y reconstruction six-years before, for the treatment of bleeding gastric ulcer.He presented with epigastric abdominal pain radiating to the back and alimentary vomiting with a 3 days evolution, with an episode of hematemesis 2 h before admission. His abdomen was bloated and tender at the epigastric region. The laboratory exams revealed mild leucocytosis and CRP elevation with normal pancreatic tests. The abdominal CT scan revealed an intestinal occlusion. An exploratory laparotomy was performed, disclosing an incarcerated Petersen space hernia of the common limb, with obstruction and dilatation of the biliary limb.
  
  
  CONCLUSIONS
  The knowledge of this anatomic post-operative defect and a low threshold for diagnosis are crucial to its management, since its nonspecific clinical and laboratory findings. Early operative intervention is warranted in order to avoid the severe complications of bowel necrosis.
authors.affiliation: Hospital de São João, Department of Surgery, Porto, Portugal.
authors.forename: G
authors.initials: G
authors.lastname: Faria
authors.forename: J
authors.initials: J
authors.lastname: Preto
authors.forename: M
authors.initials: M
authors.lastname: Oliveira
authors.forename: T
authors.initials: T
authors.lastname: Pimenta
authors.forename: M
authors.initials: M
authors.lastname: Baptista
authors.forename: J
authors.initials: J
authors.lastname: Costa-Maia
references.citation: Obes Surg. 2004 Jun-Jul;14(6):811-22
references.pmid: 15318988
references.citation: Arch Surg. 1974 Mar;108(3):363-5
references.pmid: 4813334
references.citation: Obes Surg. 2003 Jun;13(3):350-4
references.pmid: 12841892
references.citation: Abdom Imaging. 2011 Apr;36(2):126-9
references.pmid: 20473666
references.citation: J Am Coll Surg. 2008 Jul;207(1):121-4
references.pmid: 18589370
references.citation: Postgrad Med. 2008 Jul 31;120(2):E01-5
references.pmid: 18654063
references.citation: Surg Obes Relat Dis. 2005 Nov-Dec;1(6):543-8
references.pmid: 16925288
references.citation: Am J Surg. 1968 Sep;116(3):450-3
references.pmid: 5675920
references.citation: Lancet. 1981 Jun 13;1(8233):1305-7
references.pmid: 6112616
references.citation: Ann Surg. 1973 May;177(5):547-53
references.pmid: 4704039
references.citation: Am J Surg. 2004 Dec;188(6):796-800
references.pmid: 15619502
references.citation: Obes Surg. 2007 Nov;17(11):1498-502
references.pmid: 18219778
references.citation: Obes Surg. 2003 Aug;13(4):596-600
references.pmid: 12935361
references.citation: Zentralbl Allg Pathol. 1972;115(3):335-40
references.pmid: 4507033
references.citation: Surg Endosc. 2005 Jan;19(1):34-9
references.pmid: 15529196
references.citation: Obes Surg. 2006 Nov;16(11):1482-7
references.pmid: 17132415
references.citation: Surg Obes Relat Dis. 2006 Mar-Apr;2(2):87-91
references.pmid: 16925328
references.citation: Cir Esp. 2007 Aug;82(2):77-88
references.pmid: 17785141