Internal hernia is an important diagnosis to consider in patients following Roux-en-Y gastric bypass surgery, told Dr. Laura R. Carucci. The diagnosis is often difficult both clinically and radiologically, and a high index of suspicion is necessary.
Dr. Carucci and colleagues from Virginia Commonwealth University Medical Center, Richmond, sought to characterize the radiographic features of internal hernia seen in 20 of 1282 gastric bypass patients upon small-bowel follow-through (SBFT).
SBFT from all 20 patients showed an atypical bowel configuration with clustered small-bowel loops, the authors report.
All studies in which a radiopaque staple line was seen on the scout film showed a change in location of the staple line from the location noted at postoperative imaging.
Clinical evidence of internal hernia was found in all 20 patients, and surgery was performed and confirmed the diagnosis in 19 patients. (The remaining patient refused surgery and left the hospital against medical advice.)
In contrast, the researchers note, SBFT findings from 21 Roux-en-Y gastric bypass patients without internal hernia showed no displacement of the staple line in any patient and atypical small-bowel configuration with clustered small bowel in only two patients.
Proper imaging technique, knowledge of post-operative anatomy, and awareness of internal hernia as a potential complication of Roux-en-Y gastric bypass procedure are essential to make this diagnosis, Dr. Carucci concluded.
