Question:

Recent studies have described seven key CT scan findings that point towards an internal hernia in patients who have undergone Roux-En-Y gastric bypass surgery. Please select the sign found to be the single best predictor of internal hernia.
1. Mushroom sign
2. Small bowel behind superior mesenteric artery
3. Right-sided anastomosis
4. Swirled mesentery
5. Distended cecum





Answer:

The correct answer for the question "Recent studies have described seven key CT scan findings that point towards an internal hernia in patients who have undergone Roux-En-Y gastric bypass surgery. Please select the sign found to be the single best predictor of internal hernia." is:

4. Swirled mesentery



Explanation

1. While this has been shown to be a sign of internal hernia, it is not the best predictor of this pathology on CT scan. (In a recent study by Lockhart et al, CT scans of 18 patients with surgically proven internal hernias were compared to CT scans of 18 patients who did not have an internal hernia. Both groups of patients had laparoscopic Roux-en Y gastric bypass procedures. This group identified seven key CT scan findings including swirled mesentery, mushroom sign, hurricane eye, small-bowel obstruction, clustered loops, small bowel behind superior mesenteric artery, and right-sided anastomosis. This group found that the single best predictor of hernia was swirled mesentery.)

2. This has been shown to be a sign of internal hernia, but is not the best predictor of this pathology on CT scan. See above.

3. This has been shown to be a sign of internal hernia, but is not the best predictor of this pathology on CT scan. See above.

4. This has been shown to be the single best predictor of internal hernia. See above.

5. This has not been shown to be a sign of internal hernia in patients who have undergone Roux-En-Y bypass. See above.



From the manuscript:
Importance of CT in Evaluating Internal Hernias after Roux-en-Y Gastric Bypass Surgery
Radiology Case. 2009 Jun; 3(6):34-37


This article belongs to the GI section.




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From the manuscript

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

Free full text article: 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%.






References



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