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Compression of the superior mesenteric vein—a sign of acute internal herniation in patients with antecolic laparoscopic Roux-en-Y gastric bypass

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To investigate whether compression of the superior mesenteric vein (SMV) on computed tomography (CT) can serve as a valid sign of internal herniation (IH) in patients with antecolic laparoscopic Roux-en-Y gastric bypass (LRYGBP).

Materials and methods

With institutional review board approval, we performed a retrospective analysis of 41 patients with antecolic LRYGBP referred for acute CT of the abdomen with suspicion of IH or another cause of acute abdomen. CT scans were randomly reviewed for signs of IH by two radiologists in a blinded manner, and the findings were correlated with the results of the patients’ bariatric workup. Sensitivity, specificity, and inter-observer agreement were calculated for each sign.

Results

Five patients were classified as having intermittent IH and were excluded. Eighteen patients were found to have IH at laparoscopy and served as the study group; 18 patients served as the control group. SMV compression had the best sensitivity (67 % for both reviewers) and inter-observer agreement (kappa = 0.82) of all investigated signs. The swirl sign showed a lower sensitivity (39 and 50 % respectively) and kappa (0.37).

Conclusion

SMV compression is a reliable sign of IH in patients with antecolic LRYGBP.

Key Points

• CT can help detect internal herniation after laparoscopic Roux-en-Y gastric bypass.

• Compression of the superior mesenteric vein is a sign of internal herniation.

• This sign has a high inter-observer-agreement.

• A diagnosis of internal herniation can be made with greater confidence.

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Abbreviations

CT:

computed tomography

IH:

internal herniation

LRYGBP:

laparoscopic Roux-en-Y gastric bypass

SMV:

superior mesenteric vein

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Acknowledgments

The scientific guarantor of this publication is Jens Maier. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was not required for this study because it was retrospective. Methodology: retrospective, case-control study/diagnostic or prognostic study/observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Køge Sygehus, Lykkebækvej 1, 4600, Køge, Denmark

    Jens Maier & Amaya Herrasti Gallego

  2. Department of Abdominal Surgery, Holbæk Sygehus, Smedelundsgade 60, 4300, Holbæk, Denmark

    Andrea K. Floyd

Authors
  1. Jens Maier
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  2. Amaya Herrasti Gallego
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  3. Andrea K. Floyd
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Correspondence to Jens Maier.

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Maier, J., Herrasti Gallego, A. & Floyd, A.K. Compression of the superior mesenteric vein—a sign of acute internal herniation in patients with antecolic laparoscopic Roux-en-Y gastric bypass. Eur Radiol 27, 1733–1739 (2017). https://doi.org/10.1007/s00330-016-4526-9

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  • DOI: https://doi.org/10.1007/s00330-016-4526-9

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