title: Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the sensitivity and specificity of seven CT signs in the diagnosis of internal hernia after laparoscopic Roux-en-Y gastric bypass.
  
  
  METHODS
  With institutional review board approval, the CT scans of 18 patients (17 women, one man) with surgically proven internal hernia after laparoscopic Roux-en-Y gastric bypass were retrieved, as were CT studies of a control group of 18 women who had undergone gastric bypass but did not have internal hernia at reoperation. The scans were reviewed by three radiologists for the presence of seven CT signs of internal hernia: swirled appearance of mesenteric fat or vessels, mushroom shape of hernia, tubular distal mesenteric fat surrounded by bowel loops, small-bowel obstruction, clustered loops of small bowel, small bowel other than duodenum posterior to the superior mesenteric artery, and right-sided location of the distal jejunal anastomosis. Sensitivity and specificity were calculated for each sign. Stepwise logistic regression was performed to ascertain an independent set of variables predictive of the presence of internal hernia.
  
  
  RESULTS
  Mesenteric swirl was the best single predictor of hernia; sensitivity was 61%, 78%, and 83%, and specificity was 94%, 89%, and 67% for the three reviewers. The combination of swirled mesentery and mushroom shape of the mesentery was better than swirled mesentery alone, sensitivity being 78%, 83%, and 83%, and specificity being 83%, 89%, and 67%, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  Mesenteric swirl is the best indicator of internal hernia after laparoscopic Roux-en-Y gastric bypass, and even minor degrees of swirl should be considered suspicious.
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, 619 19th St. S, Birmingham, AL 35249-6830, USA. mlockhart@uabmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Lockhart
authors.forename: Franklin N
authors.initials: FN
authors.lastname: Tessler
authors.forename: Cheri L
authors.initials: CL
authors.lastname: Canon
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Smith
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Larrison
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Fineberg
authors.forename: Brandon P
authors.initials: BP
authors.lastname: Roy
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Clements
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006547:Hernia / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome