J Korean Surg Soc.  2013 Dec;85(6):309-313. 10.4174/jkss.2013.85.6.309.

A Peterson's hernia and subsequent small bowel volvulus: surgical reconstruction utilizing transverse colon as a new Roux-en-Y limb - 1 case

• Jang JS
• Shin DG

• KMID: 2212559
• DOI: http://doi.org/10.4174/jkss.2013.85.6.309

Abstract

Peterson's hernia is an internal hernia that can occur after Roux-en-Y anastomosis. It often accompanies small bowel volvulus and is prone to strangulation. Reconstruction of intestinal continuity after massive small bowel resection in a patient who undergoes near total gastrectomy and Roux-en-Y anastomosis can be difficult. A 74-year-old man who had undergone a near total gastrectomy and Roux-en-Y gastrojejunostomy for stomach cancer presented with abdominal pain. The preoperative computed tomography showed strangulated small bowel volvulus. During the emergent laparotomy, we found a strangulated Peterson's hernia with small bowel volvulus. After resection of the necrotized intestine, we made a new Roux-en-Y anastomosis connecting the remnant stomach and the jejunum with a transverse colon segment. We were safely able to connect the remnant stomach and the jejunum by making a new Roux-en-Y anastomosis utilizing a transverse colon segment as a new Roux-limb by two stage operation.

Keyword

Roux-en-Y; Gastrectomy; Hernia; Volvulus

MeSH Terms

Abdominal Pain
Aged
Anastomosis, Roux-en-Y
Colon, Transverse*
Extremities*
Gastrectomy
Gastric Bypass
Gastric Stump
Hernia*
Humans
Intestinal Volvulus*
Intestines
Jejunum
Laparotomy
Stomach Neoplasms

Figure

• 

  Fig. 1 The simple abdominal X-ray and preoperative abdominal computed tomography (CT) at presentation. (A) X-ray image in the abdominal erect view showing the distended several small bowel loops with air-fluid levels. (B) CT image showing mesenteric swirl sign, nonenhancement of small bowel until the delayed phase and pneumatosis intestinalis of small bowel.

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  Fig. 2 Resected strangulated small bowel specimen image. All the small bowel loop except proximal 20 cm jejunal segment from Treiz ligment and distal 10 cm ileal segment were resected. Jejunal Roux limb which had been anastomosed to remnant stomach was also strangulated.

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  Fig. 3 Schematic diagram of the first operation shows an anastomosis of the remnant stomach and the transverse colon, an anastomosis of the proximal jejunum and the distal ileum, and a transverse colostomy.

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  Fig. 4 (A) Schematic diagram of the second operation shows an anastomosis of the ascending colon and the distal transverse colon and a new Roux-en-Y anastomosis, which is consist of two anastomoses between the remnant stomach and the transverse colon segment (as a Roux-limb) and between the transverse colon segment and the proximal jejunum. (B) This picture shows the completed reconstruction-anastomoses during the second operation.

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