Hooking intestine sign: a typical diagnostic CT finding of Petersen's hernia

Prediction of the possibility of laparoscopic reduction of Petersen's hernia after gastrectomy: multicenter observational cohort study

Introduction

Petersen’s hernia (PH) is a potentially fatal complication of bowel infarction that is difficult to treat by laparoscopic reduction.

Aim

To define predictive computed tomography (CT) profiles to identify PH patients who would be suitable for laparoscopic reduction by a comparative analysis between patients treated by laparoscopic and open reduction.

Material and methods

We retrospectively collected the clinical data of patients (n = 28) who underwent PH reduction surgery after minimally invasive gastrectomy for gastric cancer in the period 2015–2018 at four training hospitals. We examined the preoperative CT scans to identify the indications for laparoscopic PH reduction.

Results

We compared the laparoscopic reduction group (laparoscopic group, n = 15) and the open reduction group (open group, n = 13). Patients in the laparoscopic group were younger (55.7 ±10.4) than those in the open group (69.3 ±9.1), but there were no differences in clinical or laboratory findings. We found that there were two CT profiles with significant differences between the open and laparoscopic groups: superior mesenteric vein (SMV) narrowing and small bowel dilation. We found that small bowel dilatation was an independent factor on multivariate analysis for laparoscopic PH reduction.

Conclusions

We found that small bowel dilatation is the most important CT profile for identifying PH patients contraindicated for laparoscopic reduction. Despite the retrospective design of this study, these CT profiles are expected to define the scope of laparoscopic reduction in PH patients and to establish indications for the laparoscopic approach.

Normal and Abnormal Postoperative Imaging Findings after Gastric Oncologic and Bariatric Surgery

Surgical resection remains the primary choice of treatment and the only potentially curative option for gastric carcinoma, and is increasingly performed laparoscopically. Gastric resection represents a challenging procedure, with a significant morbidity and non-negligible postoperative mortality. The interpretation of imaging after gastric surgery can be challenging due to significant modifications of the normal anatomy. After the surgery, the familiarity with expected imaging appearances is crucial for diagnosis and appropriate management of potentially life-threatening complications in patients who underwent gastric surgery. We review various surgical techniques used in gastric surgery and describe fluoroscopic and cross-sectional imaging appearances of normal postoperative anatomic changes as well as early and late complications after gastric surgery.