title: Intestinal infarction by internal hernia in Petersen's space after laparoscopic gastric bypass.
abstract: 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 involvement. In our Center, from October 2009 to April 2013 we have had 17 pts treated for internal hernia on 412 LGBP (4.12%).
  
  
  METHODS
  28-year-old woman, operated of LGBP (BMI = 49; co-morbidity: diabetes mellitus and arthropathy) about 10 mo before, was affected by recurrent abdominal pain with alvus alteration lasting for a week. After 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 diagnosis. After 3 d the patient contacted our Center since her symptoms got worse and was hospitalized. Blood tests showed an alteration of hepatic enzymes and amylases. The abdominal computed tomography (CT) showed the presence of fluid in peri-splenic, 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 Vein. During the operation, we found a necrosis of 80 cm of ileus (about 50 cm downstream the jejuno-jejunal anastomosis) due to an internal hernia through Petersen's space causing a SMV thrombosis. The necrotic bowel was removed, the internal hernia was reduced and Petersen' space was sutured by not-absorbable running suture. An anticoagulant therapy was begun in the post-operative time and the patient was discharged after 28 d.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Massimiliano Fabozzi, Riccardo Brachet Contul, Paolo Millo, Rosaldo Allieta, General and Laparoscopic Surgery Department, "Umberto Parini" Aosta Valley Regional Hospital, 11100 Aosta, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fabozzi
authors.affiliation: Massimiliano Fabozzi, Riccardo Brachet Contul, Paolo Millo, Rosaldo Allieta, General and Laparoscopic Surgery Department, "Umberto Parini" Aosta Valley Regional Hospital, 11100 Aosta, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Brachet Contul
authors.affiliation: Massimiliano Fabozzi, Riccardo Brachet Contul, Paolo Millo, Rosaldo Allieta, General and Laparoscopic Surgery Department, "Umberto Parini" Aosta Valley Regional Hospital, 11100 Aosta, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Millo
authors.affiliation: Massimiliano Fabozzi, Riccardo Brachet Contul, Paolo Millo, Rosaldo Allieta, General and Laparoscopic Surgery Department, "Umberto Parini" Aosta Valley Regional Hospital, 11100 Aosta, Italy.
authors.forename: Rosaldo
authors.initials: R
authors.lastname: Allieta
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D007082:Ileum / Q000098:blood supply* / Q000601:surgery; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008642:Mesenteric Veins; D012086:Reoperation; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
chemical_list: D000925:Anticoagulants
keywords: Internal hernia; Intestinal infarction; Laparoscopic gastric bypass; Petersen’s hernia; Portomesenteric thrombosis