Department of Radiology, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait.
Med Princ Pract. 2013;22(6):540-4. doi: 10.1159/000351616. Epub 2013 Aug 8.
To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients.
This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration.
Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively.
The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.
评估 64 层多层螺旋计算机断层扫描（MDCT）在诊断 Roux-en-Y 胃旁路（RYGB）后肥胖症患者发生肠系膜内疝的准确性。
本回顾性研究对象为 2010 年 4 月至 2012 年 3 月在我院就诊的具有肠系膜内疝表现的 RYGB 术后肥胖症患者。有肠系膜内疝表现的患者进行 64 层 MDCT 检查。所有 CT 检查提示有肠系膜内疝特征的患者均接受腹腔镜探查。
在 102 例行腹腔镜 RYGB 的患者中，42 例（41.2%）疑似有内疝。其中，23 例（55%）CT 检查有疝的表现，而其余 19 例（45%）被认为正常。在这 23 例中，21 例（91%）患者在腹腔镜检查中被证实有内疝。19 例（45%）CT 检查无内疝征象和 2 例腹腔镜检查正常的患者接受保守治疗。MDCT 诊断肠系膜内疝的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、90.5%、91%和 91.3%。
64 层 MDCT 对 RYGB 后肥胖症患者肠系膜内疝的诊断是准确的。肠系膜漩涡状聚集肠袢是肠系膜内疝的可靠征象。
