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Delayed diagnosis of Petersen hernia in the third trimester of pregnancy: case presentation and literature review


Obstetrics & Gynecology International Journal
Neil Patel,1,2 Zachary Sandman,1 Jude Wafai,1,2 Dmitry Youshko1

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Abstract

Petersen’s Hernia, a type of internal hernia that occurs posterior to a gastrojejunostomy, is a known late complication of gastric bypass surgery, particularly prevalent in laparoscopic Roux-en-Y procedures (LRYGB). The rise in laparoscopic gastric bypass procedures has coincided with a resurgence of Petersen’s Hernia cases.1 LRYGB surgeries performed on women of reproductive age improve fertility and pregnancy outcomes.2 However, pregnancy predisposes these patients to Petersen’s hernia due to the increased intraabdominal pressure and anatomical distortion.3 We present a case of Petersen’s hernia that occurred in a 29-year-old at 30 weeks gestation who had previously undergone LRYGB, notable for a delay in diagnosis. Pregnant patients with a history of bariatric surgery should be considered at high-risk for internal hernias. Abdominal or back pain associated with nausea and vomiting should prompt consideration of internal hernia and the need for imaging and surgical evaluation.

Keywords

roux-en-Y bypass, hernia, intestinal obstruction, hernia in pregnancy, petersens hernia

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