Internal Hernia After Gastric Bypass: Sensitivity and Specificity of Seven CT Signs with Surgical Correlation and Controls
Mark E. Lockhart1,
Franklin N. Tessler1,
Cheri L. Canon1,
J. Kevin Smith1,
Matthew C. Larrison1,
Naomi S. Fineberg2,
Brandon P. Roy3,4 and
Ronald H. Clements3
1 Department of Radiology, University of Alabama at Birmingham, 619 19th St. S,
Birmingham, AL 35249-6830.
2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham,
AL 35294-0022.
3 Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
35249-0016.
4 Present address: Department of Surgery, WakeMed Hospital, Raleigh, NC
27610.
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Fig. 1 —39-year-old woman with internal hernia. CT sign, mesenteric swirl.
Enhanced transverse CT scan through mesentery shows swirled appearance of
mesenteric vessels (arrows) in superior mesenteric artery region.
Associated mild mesenteric edema appears as increased attenuation of
mesenteric fat.
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Fig. 2 —35-year-old woman with internal hernia. CT sign, small-bowel
obstruction. Enhanced transverse CT scan shows numerous dilated loops of small
bowel, which contain oral contrast medium. Colon is relatively collapsed.
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Fig. 3 —36-year-old woman with internal hernia. CT sign, clustered loops of
small bowel. Magnified enhanced transverse CT scan of bowel loops shows
grouping of nondilated small-bowel loops (arrow) near anterior
abdominal wall.
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Fig. 4 —35-year-old woman with internal hernia. CT sign, mushroom-shaped
mesenteric root. Enhanced transverse CT scan through mesenteric root shows
narrowed mesenteric root with fat and vessels passing between superior
mesenteric artery (arrow) and distal mesenteric arterial branch
(arrowhead). Contrast agent-filled loops of small bowel are narrowed
as they pass through this region. Stretching of mesenteric vessels in this
area is evident.
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Fig. 5 —34-year-old woman with internal hernia. CT sign, distal tubular
mesentery with surrounding loops of small bowel. Enhanced transverse CT scan
at level of loops of small bowel shows round appearance of distal mesenteric
fat (arrows) with small-bowel loops completely surrounding this
region. Similar appearance was present on adjacent images (not shown) and was
consistent with tubular twisted shape of distal mesenteric fat.
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Fig. 6 —35-year-old woman with internal hernia. CT sign, small-bowel loop
behind superior mesenteric artery. Enhanced transverse CT scan shows distal
small-bowel loop (arrows) posterior to superior mesenteric artery. No
bowel loop should lie in this position after laparoscopic Roux-en-Y gastric
bypass. This loop usually is stretched distal ileum coursing from its
insertion into cecum to internal hernia.
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Fig. 7 —34-year-old woman with internal hernia. CT sign, right-sided
anastomosis. Enhanced transverse CT scan at level of small bowel shows suture
line of distal jejunojejunal anastomosis (arrows) to right of
midline. At our institution, anastomosis is always positioned on left side of
abdomen, and right-sided location is suggestive of internal hernia.
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Copyright © 2007 by the American Roentgen Ray Society.
