Characteristic X-Ray Findings Help Identify Internal Hernia After Gastric Bypass Surgery

NEW YORK, June 9, 2009 — Radiographic findings at small-bowel examination can aid in the diagnosis of internal hernia following Roux-en-Y gastric bypass procedure for morbid obesity, according to a report in the June issue of Radiology.

"Internal hernia is an important diagnosis to consider in patients following Roux-en-Y gastric bypass surgery," Dr Laura R. Carucci told Reuters Health. "The diagnosis is often difficult both clinically and radiologically, and a high index of suspicion is necessary."

Dr Carucci et al from Virginia Commonwealth University Medical Center in 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 reported.

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 noted, 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 2 patients.

"Proper imaging technique, knowledge of postoperative 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.

Source: Reuters Health Information