Petersen's hernia with chylous ascites following laparoscopic total gastrectomy and Roux-en-Y anastomosis: A case report and review of literature

Abstract

BACKGROUND

Petersen’s hernia occurring through the epiploic foramen of the greater omentum, is an uncommon type of internal hernia. When it presents with complications such as chylous ascites, which is the lymphatic fluid accumulation in the abdominal cavity, it is particularly rare. Following laparoscopic total gastrectomy and Roux-en-Y anastomosis, the incidence of this condition is exceedingly low.

CASE SUMMARY

A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy (LTG) for gastric cancer, after Roux-en-Y anastomosis. Intestinal torsion and obstruction were experienced by the patient, along with a small amount of chylous ascites. Imaging studies and clinical assessment confirmed the diagnosis. Emergency surgery was performed promptly for the patient in the operating room. The twisted small intestine was reduced and the defect in Petersen’s space was repaired. The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection. The patient’s condition significantly improved following the surgery. The ascites evolved from a milky white appearance to a pale yellow, with a substantial decrease in the triglyceride levels in the ascitic fluid, implying a favorable recovery trajectory. The patient was monitored closely and received appropriate care postoperatively, including nutritional support and fluid management.

CONCLUSION

This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer. It highlights the fundamental role of early surgical intervention in the effective management of such complications. The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.

Keywords: Petersen's hernia; Chylous ascites; Laparoscopic total gastrectomy; Roux-en-Y anastomosis; Internal hernia; Case report

Core Tip: This report emphasizes the rare but critical occurrence of Petersen’s hernia complicated by chylous ascites following laparoscopic total gastrectomy and Roux-en-Y anastomosis. The report accentuates the importance of early diagnosis and prompt surgical intervention in managing this condition, significantly improving the outcomes in patients. The significance of recognizing non-specific clinical symptoms and utilization of imaging studies, particularly computed tomography scans, for accurate diagnosis, is underscored. Furthermore, the case and literature review emphasizes the need for heightened clinical vigilance and the development of effective preventive strategies to alleviate this potentially fatal postoperative complication risk.