Importance of CT in Evaluating Internal Hernias after Roux-en-Y Gastric Bypass Surgery

Abstract

As the incidence of obesity increases, laparoscopic Roux-en-Y gastric bypass (REYGB) surgery has become a surgical option for many patients. Although the laparoscopic Roux-en Y procedure has been shown to reduce weight and improve diabetes, hyperlipidemia, hypertension and sleep apnea, it is not without significant risks, as more than 10% of patients who undergo this procedure have postoperative GI complications. This is a case of a 51 year old man who presented with diffuse abdominal pain one month status-post Roux-en-Y gastric bypass. CT imaging proved to be crucial in the diagnosis of this pathology with small bowel volvulus and ischemia. We review some key CT findings that can aid clinicians in diagnosing internal hernias since this complication is often misdiagnosed and have a mortality rate of more than 50%.

PetersenÓ?s space hernia after gastric bypass

“…In this context, once other ailments such as cholelithiasis, acute pancreatitis, and ulcer of the anastomosis mouth have been ruled out, radiological investigations (contrast-enhanced abdominal CT) should be carried out 3 . Typical radiological signs of internal hernia include mesenteric vessels and mesenteric root fat whirl, mesenteric vessels engorgement, small bowel arrangement behind superior mesenteric artery, presence of jejuno-jejunal anastomosis to the right of the alimentary loop, and ligament of Treitz anterior and right displacement 11 . In our case, CT showed mesenteric vessels counterclockwise rotation.…”