Post gastric bypass transmesenteric internal hernia
Abdominal pain, distension and vomiting.
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Post gastric bypass anastomosis with marked mesenteric vessels swirling, engorgement and stretching distal to the jejuno-jejunal anastomosis, abrupt beaking of the distal jejunal loop and abnormal clustering of dilated small bowel segment measures about 3.8 cm diameter and 8 cm length showing small bowel fecal sign and mildly increased wall enhancement.
Collapsed bypassed stomach and duodenum.
Gas distended transverse colon, yet the ascending and descending colon are collapsed.
Marked free abdominopelvic fluid.
Bilateral breast augmentation.
History of gastric bypass 10 years ago for weight reduction, presented to ER with abdominal pain, distension and vomiting. Urgent CT was requested to rule out internal hernia.
After the diagnosis of transmesenteric internal hernia, the patient was operated on confirming the diagnosis of an internal hernia and viable bowel.
- Internal Hernia After Gastric Bypass: Sensitivity and Specificity of Seven CT Signs with Surgical Correlation and Controls American Journal of Roentgenology. 2007;188: 745-750. 10.2214/AJR.06.0541 doi/10.2214/AJR.06.0541
- Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass: Optimal CT Signs for Diagnosis and Clinical Decision Making Marc Dilauro, Matthew D. F. McInnes, Nicola Schieda, Ania Z. Kielar, Raman Verma, Cynthia Walsh, Andrey Vizhul, William Petrcich, and Joseph Mamazza Radiology 2017 282:3, 752-760