Post-gastric bypass internal hernia through Petersen defect with Roux limb volvulus and chyloperitoneum: Laparoscopic management

Vanessa W Hui, MD1, Ajay Chopra, MD2. 1Montefiore Medical Center, 2Jacobi Medical Center

A 27-year-old woman with a past surgical history significant for revision laparoscopic Roux-en-Y gastric bypass following a laparoscopic sleeve gastrectomy for morbid obesity now presents with two weeks of abdominal pain and clinical findings consistent with an internal hernia. During diagnostic laparoscopy, significant chyloperitoneum was noted and likely caused by an adhesive band between the transverse colonic epiploic appendage and the stapled blind end of the Roux limb, leading to a Roux limb volvulus and internal herniation of the jejunojejunostomy and biliary limb into Petersen’s space. Per our knowledge, this is the first reported case of chyloperitoneum associated with post-gastric bypass internal hernia.

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