CT diagnosis of internal hernias in post bariatric patients
Arias, F.J.; Sanchez, M.; Lev-Toaff, A.; Carrasquilla, C.
Boletin de la Asociacion Medica de Puerto Rico 110(1): 11-15
2018
ISSN/ISBN: 0004-4849 Document Number: 703075
Background: Internal hernia is a recognized cause of small bowel obstrution in patients after bariatric surgery. This entity is difficult to diagnose due to its variable imaging characteristics. Materials and Methods: We retrospectively reviewed computed tomography studies in 37 patients with surgicallyproven internal hernias after gastric bypass surgery. Seven imaging findings were applied to suggest this diagnosis. These findings are: ectopic distal anastomosis, dilatation of the excluded stomach and duodenum, dilatation of the biliary (non-alimentary) limb, dilatation of the distal (jejuno-jejunal) anastomosis, loss of normal anatomic relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), tethering and engorgement of the small bowel mesentery. Results: Three or more of these findings are strongly suggestive of internal hernia in the appropriate clinical situation which was supported by 81% of our sample. Conclusion: Knowledge of the anatomic changes that take place in post-bariatric surgery patients, as well as our reported imaging findings, is helpful to make an accurate prospective diagnosis of internal hernia utilizing computed tomography in post-bariatric patients.
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