Introduction: Internal hernias are the most common cause of intestinal obstruction after laparoscopic bariatric surgery and these can result in closed loop obstructions, bowel necrosis, bowel perforation, and even death. After laparoscopic Roux-en-Y gastric bypass surgery, there are several potential spaces for internal hernias including Petersen's defect, which occurs between the mesentery of the Roux limb and the mesentery of the transverse colon. This defect is found in both antecolic and retrocolic gastric bypass. Internal hernias are difficult to diagnose both clinically and radiographically, thus diagnosis is often made at the time of operation.

Methods: We are presenting a 54 year old male who had presented with abdominal pain three years after gastric bypass surgery with weight loss of 150 pounds. Due to his clinical presentation, an internal hernia was suspected and the patient underwent diagnostic laparoscopy. A Petersen's hernia was found and repaired laparoscopically with nonabsorbable running suture.

Results: The patient underwent repair of the hernia defect, had an uneventful recovery, and was discharged on hospital day 2.

Conclusion: Internal hernias should be suspected in a patient presenting with recurrent colicky abdominal pain with a history of significant weight loss after laparoscopic Roux-en-Y gastric bypass surgery. The risk of developing an internal hernia is lifelong. Early and aggressive management of internal hernias after gastric bypass is essential to prevent morbidity and mortality associated with this complication.