MDCT signs predicting internal hernia and strangulation in patients presented to emergency department with acute small bowel obstruction

Abstract

Objective: We prospectively evaluate multidetector computed tomography (MDCT) criteria of internal hernia, and related complication as intestinal strangulation. Methods: 27 patients presented to emergency department with acute small bowel obstruction (ASBO) and diagnosed with MDCT as IH were included. Validity of different MDCT criteria in diagnosing IH was compared with surgical diagnosis. Results: Surgical diagnosis was 22 patients with IH (14 paraduodenal and 8 transmesenteric hernia) and 5 false positive cases. There was excellent agreement between MDCT and surgery in diagnosing paraduodenal hernia (k = 1), and good agreement in diagnosing transmesenteric hernia (k = 0.624). Significant MDCT criteria include the following: cluster of small-bowel (p < 0.0001); mass effect to surrounding (p = 0.009); crowding of mesenteric vessels (Swirl's sign) (p = 0.01). Sensitivity, specificity, PPV, NPV and accuracy of MDCT in diagnosing strangulation were 83%, 100%, 100%, 95%, and 96% respectively. MDCT signs for detecting strangulation were statistically significant and varied from highly significant for bowel-wall thickening and mesenteric vessel engorgement (p < 0.001) to significant for abnormal bowel-wall enhancement, mesenteric infiltrate and mesenteric fluid with p value = 0.001. Conclusion: MDCT helps in early diagnosis of IH and strangulation, which accounts for appropriate management of such emergent cases.

Keywords

• Internal hernia
• Multidetector CT
• Small bowel strangulation