Department of Surgery, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China.
Department of Gerontology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China.
Sci Rep. 2019 Sep 6;9(1):12847. doi: 10.1038/s41598-019-48241-x.
Internal hernia (IH)-related surgical acute abdomen is not well understood because of the rarity of cases and underdiagnosis. This study was performed to further understand the clinicopathological features and multi-detector computed tomography (MDCT) findings of IH in cases confirmed by surgery. In all, 51 patients with a definite diagnosis of IH confirmed during surgical exploration from Feb. 2012 to Feb. 2018 in our hospital were included in this research. Medical records, including MDCT images and intra-operative findings, were collected retrospectively. In all, 39 and 12 cases were categorized as adhesive IH (76.5%) and non-adhesive IH (23.5%), respectively. Among the patients with adhesive IH, 73% had a history of abdominal or pelvic surgery. Additionally, the mesentery was the most common component of adhesive bands (64.1%). Congenital peritoneal abnormalities and gastrointestinal reconstruction were the main causes of non-adhesive IH.As a specific sign, the fat notch sign was much more common in adhesive IH than in non-adhesive IH (P = 0.023). Bowel wall thickening (P = 0.041), abnormal bowel wall enhancement (P = 0.006) and twisted bowels with the vessel swirl sign (P = 0.004) were indicators of bowel necrosis. Among all of the cases of IH, 34 (66.7%) were complicated by bowel necrosis, and 1 patient died. In conclusion, non-adhesive IH has different clinicopathological features and MDCT findings from those of adhesive IH. MDCT is a useful tool with high sensitivity for confirming IH and may help to guide the early treatment of IH.
内疝（IH）相关的外科急腹症并不常见，因此容易漏诊，导致对其认识不足。本研究旨在进一步了解经手术证实的 IH 的临床病理特征和多排螺旋 CT（MDCT）表现。本研究共纳入我院 2012 年 2 月至 2018 年 2 月期间因 IH 行手术探查而明确诊断的 51 例患者。回顾性收集了包括 MDCT 图像和术中所见在内的病历资料。所有患者中，39 例（76.5%）为粘连性 IH，12 例（23.5%）为非粘连性 IH。粘连性 IH 中，73%的患者有腹部或盆腔手术史。此外，肠系膜是粘连带最常见的组成部分（64.1%）。先天性腹膜异常和胃肠道重建是导致非粘连性 IH 的主要原因。作为一个特定的征象，脂肪切迹征在粘连性 IH 中比非粘连性 IH 更常见（P=0.023）。肠壁增厚（P=0.041）、肠壁异常强化（P=0.006）和扭曲的肠管伴血管漩涡征（P=0.004）是肠坏死的指标。所有 IH 患者中，34 例（66.7%）并发肠坏死，1 例患者死亡。总之，非粘连性 IH 的临床病理特征和 MDCT 表现与粘连性 IH 不同。MDCT 是一种有用的工具，对 IH 的诊断具有较高的敏感性，有助于指导 IH 的早期治疗。
