Diagnostic utility of CT scans in detecting internal hernias after laparoscopic Roux-en-Y gastric bypass

Mohammad Farukhi, MD, Benjamin Clapp, MD, Alan Tyroch, MD, Jayanta Gupta, MD, PhD, Christopher Dodoo, MS, Michael Mattingly, BS. Texas Tech Paul F Foster School of Medicine

BACKGROUND: Gastric bypass patients can present in the acute setting with clinical symptoms of obstruction such as abdominal pain, nausea, and vomiting. Internal hernias (IH) are an important cause of small bowel obstruction (SBO). Identifying the cause of SBO on radiographic imaging is crucial as internal hernias are a known surgical emergency.

STUDY DESIGN: Data from laparoscopic Roux-en-Y gastric bypass patients that presented with signs and symptoms of SBO from 2010 to 2014 were retrospectively analyzed. All patients with obstruction-like complaints that had a CT scan on admission and were taken to the operating room for diagnostic laparoscopy were included.

RESULTS: Obstruction was found on CT in 34 patients after laparoscopic Roux-en-Y gastric bypass. Six of the 34 patients were more specifically preoperatively diagnosed with IH by CT. All patients underwent surgical evaluation. Causes of SBO on operative findings included internal hernias (n = 14), adhesions (n = 17), jejunojejunostomy stenosis (n = 2), and other (n = 1). Four of the 6 internal hernias found on CT had consistent findings in the OR. Sensitivity of internal hernia on CT scans was found to be 28.6% with specificity of 90.0%.

CONCLUSIONS: Detecting internal hernias after gastric bypass remains a challenge. We found CT to have a low sensitivity of 28.5% but a high specificity of 90% for detecting internal hernias in patients who present with signs of acute obstruction after laparoscopic gastric bypass. Laparoscopic exploration remains the most appropriate and definitive treatment for this complication.

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