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Role of CT imaging in discriminating internal hernia from aspecific abdominal pain following Roux-en-Y gastric bypass: a single high-volume centre experience

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Abstract

Internal hernia (IH) represents a delayed complication of the laparoscopic Roux-en-Y gastric bypass (LRYGB) and it is historically difficult to identify preoperatively. Numerous CT signs were considered suggestive of IH but none of them is pathognomonic. In this study, we aim to evaluate the accuracy of CT in diagnosing IH, differentiating from non-specific abdominal pain. This can lead to a way of personalized medicine and improve the outcome of anti-obesity treatments. We retrospectively reviewed CT scans of 50 patients previously subjected to LRYGB procedure, with a clinical suspicion of IH. 3 groups of patients were identified: IH group (21 patients with a surgical confirmed IH), negative group (12 patients in whom IH was not confirmed at surgery), and control group (17 patients who were not surgically explored because of low/no suspicion of IH). We divided CT signs into three groups: “bowel loop signs”, "vessel signs”, and “venous congestion/stasis signs”. The accuracy of CT in detecting IH was tested by comparing each sign, either individually or in combination, with the surgical findings. Statistical analysis showed that “vessel signs” (swirl sign, superior mesenteric vein beaking, mesenteric arteries, and veins branches inversion) present the highest distribution in patients with IH demonstrated at surgery, with a higher accuracy in case of simultaneous presence of two or three signs. CT imaging is highly accurate in diagnosing IH. Despite no single sign being pathognomonic, the combination of two or more signs, especially among the “vessels signs”, can suggest the IH, even in pauci-symptomatic patients.

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Acknowledgements

We thank Dr. Amato Infante for his support on statistical analysis of data, Dr. Luigi Ciccoritti for data acquisition and interpretation, and Prof. Danza for his significant contribution on study conception and critical revision of the manuscript.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy

    Veronica Bordonaro, Maria Gabriella Brizi, Amato Infante, Francesco Maria Danza & Riccardo Manfredi

  2. Istituto di Radiologia, Università Cattolica Sacro Cuore, Rome, Italy

    Veronica Bordonaro, Maria Gabriella Brizi, Francesco Maria Danza & Riccardo Manfredi

  3. Unità di Radiodiagnostica, Università Campus Bio-Medico di Roma, Rome, Italy

    Francesca Lanza

  4. Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-urologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Pierpaolo Gallucci, Piero Giustacchini, Luca Sessa, Luigi Ciccoritti & Marco Raffaelli

  5. Chirurgia Endocrina e Metabolica, Department of Endocrine and Metabolic Surgery, Mater Olbia Hospital, Olbia, Italy

    Piero Giustacchini

  6. Istituto di Semeiotica Chirurgica, Università Cattolica Sacro Cuore, Rome, Italy

    Marco Raffaelli

Authors
  1. Veronica Bordonaro
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  2. Maria Gabriella Brizi
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  3. Francesca Lanza
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  4. Pierpaolo Gallucci
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  5. Amato Infante
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  6. Piero Giustacchini
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  7. Luca Sessa
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  8. Luigi Ciccoritti
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  9. Francesco Maria Danza
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  10. Riccardo Manfredi
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  11. Marco Raffaelli
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Corresponding author

Correspondence to Veronica Bordonaro.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Permission was granted by the Institutional Review Board for this retrospective study.

Research involving human participants and/or animals

The present study complies with the guidelines for human studies.

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Informed consent was obtained from all individual participants included in the study.

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Bordonaro, V., Brizi, M.G., Lanza, F. et al. Role of CT imaging in discriminating internal hernia from aspecific abdominal pain following Roux-en-Y gastric bypass: a single high-volume centre experience. Updates Surg 72, 1115–1124 (2020). https://doi.org/10.1007/s13304-020-00767-w

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  • DOI: https://doi.org/10.1007/s13304-020-00767-w

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