title: Contribution of Computed Tomographic Imaging to the Management of Acute Abdominal Pain after Gastric Bypass: Correlation Between Radiological and Surgical Findings.
abstract: We evaluated the diagnostic accuracy of first interpretations of computed tomographic (CT) images and blind interpretation using predefined CT signs in patients with previous Roux-en-Y gastric bypass (RYGBP) and acute abdominal pain.
  
  
  
  We performed a retrospective chart review of patients with RYGBP who underwent surgical exploration from January 2009 to December 2014 for acute abdominal pain in our university institution, excluding patients without CT scan and comparing initial CT imaging interpretation with surgical findings. Two blinded radiologist specialists in bariatric imaging evaluated the CT images for seven previously reported CT signs. We then calculated the sensitivity and specificity of these signs and Cohen's kappa inter-observer agreement for diagnosing internal hernia.
  
  
  
  Sixty-four patients had a recorded CT scan. The original CT interpretation showed that 26/64 (40%) patients had an accurate diagnosis. Cohen's kappa coefficient for concordance between surgical exploration and first interpretation was 0.26. The image review showed an accurate diagnosis was obtained in 51/64 patients (79.6%) and 48/64 (75%) patients for the first and second reader, respectively (Cohen's kappa coefficient = 0.67; 95% confidence interval = 0.52-0.76). The most prevalent sign indicating internal hernia was whirling of the mesentery (sensitivity = 82-91%; specificity = 79-93.1%).
  
  
  
  CT is an important diagnostic tool for skilled readers for managing acute abdominal pain in patients with previous RYGBP. Experience in the abdominal and bariatric imaging and the use of predetermined CT image signs provided a high degree of accuracy and confidence. A low threshold for surgical exploration remains the gold standard of appropriate treatment.
authors.affiliation: Department of Radiology, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Karila-Cohen
authors.affiliation: Department of Radiology, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cuccioli
authors.affiliation: Department of General and Digestive Surgery, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Tammaro
authors.affiliation: Department of Hepato-gastro-enterology, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Pelletier
authors.affiliation: Department of General and Digestive Surgery, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gero
authors.affiliation: Department of General and Digestive Surgery, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
authors.affiliation: Department of Radiology, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.affiliation: Department of General and Digestive Surgery, University Hospital Bichat Claude Bernard Paris France, 46 rue Henri Huchard, 75877, Paris, CEDEX 18, France. konstarapis@hotmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Arapis
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D059787:Acute Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Acute abdominal pain; Bariatric surgery; Computed tomography; Internal hernia; Small bowel obstruction