Monday, April 19, 2021

Internal Hernias

EmDocs - April 19, 2021 - Authors: Nicholas Alsofrom and Katie Wells
Reviewed by: Marina Boushra; Alex Koyfman; Brit Long
  • Consider internal hernia as a cause for small bowel obstruction in any patient. Those with a history of surgeriesrequiring Roux-en-Y technique such as gastric bypass or liver transplant are at higher risk, but internal hernias can occur in the surgically naïve patient as well, particularly if there is concern for a mechanism causing a mesenteric injury such as blunt abdominal trauma causing a mesenteric tear.11
  • CT scan with intravenous contrast is the first line imaging modality in stable patients with suspected internal hernia. In the setting of Roux-en-Y procedures, the most sensitive and specific sign is the mesenteric swirl. However, any SBO, particularly a closed loop SBO, should raise concern for the diagnosis.
  • If internal hernia is strongly suspected or confirmed, urgent surgical consultation and exploration is required due to the high prevalence of bowel strangulation and infarction.
  • Sepsis is a large contributor to mortality associated with any type of bowel ischemia; if intestinal necrosis or ischemia is suspected broad-spectrum antibiotics should be administered early.”