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Petersen's hernia after living donor liver transplantation

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Title: Petersen's hernia after living donor liver transplantation
Authors: Sakamoto, Sodai Browse this author
Goto, Ryoichi Browse this author
Kawamura, Norio Browse this author
Koshizuka, Yasuyuki Browse this author
Watanabe, Masaaki Browse this author
Ota, Minoru Browse this author
Suzuki, Tomomi Browse this author →KAKEN DB
Abo, Daisuke Browse this author
Yamashita, Kenichiro Browse this author →KAKEN DB
Kamiyama, Toshiya Browse this author →KAKEN DB
Taketomi, Akinobu Browse this author →KAKEN DB
Shimamura, Tsuyoshi Browse this author →KAKEN DB
Keywords: Living donor liver transplantation
Petersen's hernia
Biliary reconstruction
Issue Date: 23-Aug-2017
Publisher: Springer
Journal Title: Surgical case reports
Volume: 3
Start Page: 89
Publisher DOI: 10.1186/s40792-017-0364-5
Abstract: Background: Hepaticojejunostomy may be used for biliary reconstruction in certain cases of liver transplantation. In this occasion, Roux-en-Y biliary reconstruction is predominantly performed. Petersen's hernia is an internal hernia that can occur after Roux-en-Y reconstruction, and it may lead to extensive ischemic changes affecting incarcerated portions of the small bowel or Roux limb resulting in severe complications with a poor prognosis. Case presentation: The present case was a 44-year-old male who underwent living donor liver transplantation (LDLT) for familial amyloid polyneuropathy and in whom biliary reconstruction was performed with Roux-en-Y hepaticojejunostomy. Two years after liver transplantation, symptomatic bowel strangulation was diagnosed by CT examination and emergent surgery was performed accordingly. On exploration, an ischemic limb associated with Petersen's hernia was observed. Although repositioning of the incarcerated bowel loop gradually improved the color of the limb, the limb failed to completely recover to a normal color. To allow accurate evaluation for the viability of the limb, we decided to perform a second-look operation after 48 h. On re-exploration, the surface of the limb remained a dark color; however, intraoperative endoscopic findings revealed only partial necrosis of the mucosa. Next, we resected the portion of ischemic damaged limb only following side-to-side jejunojejunostomy. Consequently, redoing of biliary reconstruction could be avoided and the original hepaticojejunostomy site was preserved. Although the stricture of the remnant Roux limb occurred 1 month thereafter, it was successfully managed by balloon dilation via percutaneous transhepatic biliary drainage route. Conclusions: The occurrence of Petersen's hernia should always be considered in cases of liver transplantation with Roux-en-Y biliary reconstruction. On the basis of an accurate assessment of the extent of jejunal limb injury, reanastomosis of the hepaticojejunostomy, a potentially high-risk surgical procedure, can be avoided in emergent situations.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
国際連携研究教育局 : GI-CoRE (Global Institution for Collaborative Research and Education : GI-CoRE) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
国際連携研究教育局 : GI-CoRE (Global Institution for Collaborative Research and Education : GI-CoRE) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 嶋村 剛

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