Recurrent internal hernia in pregnant patients with revisional gastrojejunal bypass: diagnostic and surgical challenge. Case report and literature review

Abstract

Background. Internal hernia is a recognized late complication of Roux-en-Y gastric bypass, with a reported incidence ranging from 0.2% to 11%. Its risk increases during pregnancy due to progressive intra-abdominal pressure, and diagnosis is often challenging given symptomatic overlap with obstetric conditions. Case presentation. We report the case of a 30-year-old woman with a history of laparoscopic sleeve gastrectomy converted to Roux-en-Y gastric bypass due to refractory late sleeve stenosis. Eight months after the surgical conversion, at 22.6 weeks of gestation, she developed abdominal pain and bilious emesis; computed tomography revealed a transmesocolic internal hernia, confirmed by diagnostic laparoscopy, with partial dehiscence of the inter-mesenteric defect closure and an adequately closed Petersen's space. Three months later, during the postpartum period, the patient presented a partial recurrence of the hernia at the same defect site, managed with a third laparoscopic intervention, with favorable postoperative outcomes in both cases. Conclusion. This case highlights the persistent nature of internal hernia risk following gastric bypass, particularly in the context of pregnancy and the postpartum period, as well as the ongoing risk of recurrence despite an initially adequate mesenteric closure. It underscores the need for a high index of suspicion and long-term multidisciplinary follow-up in this patient population.