Obstetricians need to be aware of known complications related to bariatric surgeries and the diagnostic difficulties in pregnancy.
We report a rare case of G2P1 28 year old with previous laparoscopic Roux-en-Y gastric bypass surgery. She had an uncomplicated first pregnancy seven months post bariatric surgery following 44 kg weight loss. This resulted in a normal vaginal delivery at term. Eight months later she became pregnant again after a further 15kg loss. From 28/40 she presented with intermittent upper abdominal pain and nausea after eating. At 31/40 she was admitted with US revealing free fluid around the liver and prominent dilated loops of bowel. Rapid clinical deterioration prompted immediate CT scan demonstrating an internal hernia and closed loop bowel obstruction. An emergency caesarean section and laparotomy confirmed a type C Petersen’s hernia with subsequent small bowel ischaemia. 1 An extensive amount of small bowel was resected with the ends temporarily stapled. Following abdominal packing and ITU stabilisation, she returned to theatre within 24 h for reversal of the gastric bypass. Mother and baby recovered well.
Petersen’s space is created by the boundaries of the transverse mesocolon, the retroperitoneum and the ‘Roux limb’ mesentery.1 A Petersen’s hernia can arise from any type of gastrojejunostomy, leading to bowel incarceration and obstruction. Decreases in intra-abdominal fat with weight loss cause widening of the mesenteric defects and increased propensity to herniation.2 Our case demonstrates the subtlety with which such complications can present and highlights to Obstetricians not to be falsely reassured by a previous normal pregnancy.
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