Background

This is a case of internal hernia in a patient with a remote history of a laparoscopic antecolic antegastric roux-en-y gastric bypass. The patient is a 55-year-old female who presented to the emergency room with 1 day of abdominal pain, nausea and emesis. Workup including CT was notable for mesenteric swirling and dilation of the proximal bowel, gastric remnant and duodenum. There were no signs or symptoms of bowel ischemia. She was brought to the OR for diagnostic laparoscopy where an internal hernia was found containing a significant portion of the common channel and JJ. The location of the hernia was found between the proximal alimentary limb and gastric remnant. Running non-absorbable suture was used to close this space to prevent further herniation. She was discharged post-operative day one with uneventful course. The location of this hernia is distinct from the commonly referred to Petersen's space, which is described as between the transverse mesocolon and roux limb. It is critical to be familiar with all possible iterations of anatomy, and to obtain as much history about prior operations, during explorations in patients with history of bariatric surgery.