Iannuccilli J D, Grand D, Murphy B L, Evangelista P, Roye G D, Mayo-Smith W
Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
Clin Radiol. 2009 Apr;64(4):373-80. doi: 10.1016/j.crad.2008.10.008. Epub 2008 Dec 16.
To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery.
Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs.
Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign (kappa=0.48-0.79), but agreement was relatively poor for all other signs.
Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.
评估先前报道的8种计算机断层扫描（CT）征象在诊断Roux-en-Y胃旁路术后肠系膜内疝中的敏感性和特异性。
3名放射科医生以盲法回顾了9例经手术证实为胃旁路手术并发症的肠系膜内疝患者以及10例匹配的对照患者的术前CT图像。评估先前报道的8种肠系膜内疝征象的存在情况：肠系膜漩涡征、飓风眼征、蘑菇征、小肠梗阻、聚集的小肠袢、位于肠系膜上动脉（SMA）后方的非十二指肠小肠、空肠吻合口位于中线右侧以及肠系膜淋巴结肿大。计算每种征象的敏感性和特异性，以及观察者之间识别这些征象的可靠性。
肠系膜漩涡是内疝最具预测性的征象（敏感性78%-100%，特异性80%-90%）。其他CT征象显示出良好的特异性（70%-100%），但敏感性较低（0%-44%）。发现小肠梗阻和肠系膜淋巴结肿大在预测潜在疝的存在方面具有100%的特异性。观察者之间在检测肠系膜漩涡征方面有实质性的一致性（kappa=0.48-0.79），但对所有其他征象的一致性相对较差。
肠系膜漩涡是一种易于识别的CT征象，是Roux-en-Y胃旁路术后内疝的最佳指标。其他报道的CT征象诊断不敏感。小肠梗阻伴肠系膜淋巴结肿大在诊断肠系膜内疝方面具有高度特异性。
