Sanchez Joseph E, Jones Whitney N, Vitello Dominic, Prinz Joanne, Wood Cecil G, Horowitz Jeanne M, Hungness Eric S, Teitelbaum Ezra N
Research, & Education in Surgery (NQUIRES), Northwestern Quality Improvement, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Surg Endosc. 2025 Aug 18. doi: 10.1007/s00464-025-11952-6.
The radiographic diagnosis of internal hernia following Roux-en-Y gastric bypass (RYGB) can be difficult. Here, we sought to improve the detection of internal hernias through the implementation of a structured CT reporting tool.
This is a single-institution, retrospective cohort study of RYGB patients presenting to the Emergency Department. In 2023, an educational seminar and a structured CT tool were both implemented to incorporate the signs of internal hernia into CT reads. The tool incorporates the following: Antecolic/retrocolic Roux limb, jejunojejunostomy sidedness, abnormalities of the superior mesenteric vein, presence of mesenteric swirl or mesenteric edema, small bowel obstruction, small bowel clustering, bowel loops located posterior to the Roux limb mesentery, any significant changes in bowel loop configuration from prior CT scans, and a final impression of the presence or absence of internal hernia. A Pre-Intervention period of 1 year was used to compare CT scans 1 year after the implementation.
During the Pre-Intervention period, 139 CT scans were obtained. Five (3.0%) radiographic diagnoses of internal hernia were made, four of which underwent operative reduction. Six internal hernias (3.7%) were missed by CT. All six required surgical reduction, with one experiencing entire small bowel necrosis resulting in resection and small bowel transplantation. During the Post-Intervention period, 49.7% of the 193 CT scans included the structured CT reporting tool. Eight (3.7%) radiographic diagnoses of internal hernia were made, six of which underwent operative reduction. Two diagnoses of internal hernia were missed on CT scan (1.1%). The sensitivity for internal hernia detection in the Pre- and Post-Intervention groups was 40.0 vs. 75.0% (p = 0.14), and the specificity was 99.2 vs. 98.9%, respectively (p = 0.79).
Implementing a structured tool for the detection of internal hernias with CT scans may improve the diagnosis rates of internal hernia among those who have undergone RYGB.
Roux-en-Y胃旁路术（RYGB）后内疝的影像学诊断可能具有挑战性。在此，我们试图通过实施一种结构化CT报告工具来提高内疝的检出率。
这是一项针对到急诊科就诊的RYGB患者的单机构回顾性队列研究。2023年，开展了一次教育研讨会并实施了一种结构化CT工具，将内疝的征象纳入CT解读中。该工具包括以下内容：Roux袢的结肠前/结肠后位置、空肠吻合口的侧别、肠系膜上静脉异常、肠系膜漩涡或肠系膜水肿的存在情况、小肠梗阻、小肠聚集、位于Roux袢系膜后方的肠袢、与之前CT扫描相比肠袢形态的任何显著变化，以及内疝存在与否的最终印象。采用1年的干预前期来比较实施后1年的CT扫描结果。
在干预前期，共获得139份CT扫描结果。做出了5例（3.0%）内疝的影像学诊断，其中4例接受了手术复位。CT漏诊了6例内疝（3.7%）。所有6例均需要手术复位，其中1例出现全小肠坏死，导致小肠切除和小肠移植。在干预后期，193份CT扫描结果中有49.7%纳入了结构化CT报告工具。做出了8例（3.7%）内疝的影像学诊断，其中6例接受了手术复位。CT扫描漏诊了2例内疝诊断（1.1%）。干预前组和干预后组内疝检测的敏感性分别为40.0%和75.0%（p = 0.14），特异性分别为99.2%和98.9%（p = 0.79）。
实施一种用于通过CT扫描检测内疝的结构化工具可能会提高RYGB术后患者内疝的诊断率。
