Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery.
OBJECTIVE
To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients.


METHODS
This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration.


RESULTS
Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively.


CONCLUSIONS
The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.
Department of Radiology, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait.
Osama
O
Al-Saeed
Dalia
D
Fahmy
Osama
O
Kombar
Ali
A
Hasan
D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007730:Kuwait; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D061330:Multidetector Computed Tomography; D009765:Obesity / Q000000981:diagnostic imaging / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies