SHM Converge Scientific Abstract ePoster Gallery-Tangled Up in You: Petersen's Hernia

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This case describes a 53-year-old woman with a prior Roux-en-Y gastric bypass who was admitted for surgical repair of a femoral neck fracture after a mechanical fall. Shortly after an uncomplicated orthopedic surgery, she developed sudden severe abdominal pain and hypotension, raising concern for an acute abdomen.<br /><br />Her initial evaluation showed marked hypotension, pallor, diaphoresis, and right upper quadrant tenderness. Early labs were largely unremarkable, though subsequent blood gas testing showed worsening acidosis and a rising lactate. The differential diagnosis after hip surgery included ischemic bowel injury, small bowel obstruction, perforated ulcer, acute cholecystitis, colonic pseudo-obstruction, propofol-induced pancreatitis, and volvulus/internal hernia.<br /><br />Because of her history of Roux-en-Y gastric bypass, she underwent urgent laparoscopic exploration. Surgeons found her entire small bowel herniated through a Petersen defect, causing volvulus and mesenteric twisting. The bowel was detorsed, reduced, and the defect was closed, followed by an uncomplicated recovery.<br /><br />The presentation highlights several teaching points: acute abdominal pain after orthopedic surgery is uncommon but can reflect serious intra-abdominal pathology, not just prosthesis-related issues. Petersen’s hernia is an internal hernia that occurs after Roux-en-Y bypass when bowel passes through the space between the Roux limb mesentery and the transverse mesocolon. It can lead to bowel obstruction, volvulus, and ischemia. Surgical positioning, such as lateral decubitus during hip surgery, may have contributed to the event in this patient.<br /><br />Clinicians should maintain a broad differential for postoperative abdominal pain, especially in patients with prior bariatric surgery, and use CT imaging early when internal hernia is suspected.

Asset Subtitle

Nicole Bonk

Meta Tag

Author List Nicole Bonk, Tyler Will

Category Clinical Vignettes

Concept Abdominal Pain

Concept Petersen Hernia

Concept Hemodynamic Instability

Concept Internal Hernia

Concept Roux-en-Y Gastric Bypass

Distinguished Non-Finalist

Presenter Organization University of Wisconsin

Presenting Author Nicole Bonk

Track Adult

Keywords

Roux-en-Y gastric bypass

Petersen hernia

internal hernia

small bowel volvulus

postoperative abdominal pain

femoral neck fracture

orthopedic surgery

mesenteric twisting

bowel obstruction

laparoscopic exploration

Abdominal Pain

Petersen Hernia

Hemodynamic Instability

Internal Hernia

Roux-en-Y Gastric Bypass