The incidence of internal hernias in laparoscopic Roux-en-Y gastric bypass is 0.5-9.7%2,7. The diagnosis of intestinal obstruction should always be suspected in the presence of abdominal pain in patients previously submitted to it laparoscopically. Internal hernias are the main causes of intestinal obstruction after this surgical procedure14, and may occur through the mesenteric breach at the level of the enteroenteral anastomosis or the Petersen space, located between the transverse mesocolon and the mesentery of the alimentary loop elevated to the gastric pouch via antecolic and antegastric route. The most frequent intestinal obstruction, and also more severe, is that resulting from a Petersen hernia involving the biliopancreatic loop, because it has a closed loop.
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