So Jung Lee, Presenter: Nothing to Disclose

Ah Young Kim MD, Abstract Co-Author: Nothing to Disclose

Seong Ho Park MD, Abstract Co-Author: Research Consultant, INFINITT Healthcare Co, Ltd

Hyun Kwon Ha MD, Abstract Co-Author: Nothing to Disclose

To determine diagnostic MDCT findings in differentiating internal hernia from adhesion in patients with problematic small bowel obstruction(SBO).

Abdominopelvic CT scans obtained in 40 patients with problematic SBO were retrospectively reviewed by two gastrointestinal radiologists. All the patients underwent MDCT scan and surgical correction within 3-4 days. They consisted of 16 patients with internal hernia (two paraduodenal, 14 transmesenteric) and 24 patients with adhesive fibrotic band. In a random and blinded fashion, images were reviewed by the consensus of two radiologists. The presence of image finding was assessed; degree of SBO, number of transition zone, vascular crossing sign, clustered small bowel, whirl sign, stretching mesenteric vessel, and engorged mesenteric vessel. Statistical analyses were performed using the Fisher’s exact test. Individual CT signs relevant as predictors of internal hernia were evaluated with logistic regression analysis.

In all cases, transition zone of obstructive small bowel was well delineated on CT scan. But the finding of two transition zones by approximated bowel loops was highly depicted in the internal hernia group with statistical significance (93.7% vs. 16.7%, p=0.0001). Among various CT parameters, crossing vessel sing was significantly detected in the internal hernia group (75% vs. 25%, p= 0.0001). On multifactorial logistic regression analysis, two transition zones (p=0.0001) and crossing vessel sign (p= 0.005) were independent significant variables in differentiating internal hernia from adhesive SBO.

In patients with problematic SBO, characteristic CT features such as the two transition zones and crossing vessel sign are highly valuable in differentiating internal hernia from adhesive SBO.

Adhesion may warrant a trial of conservative therapy, but most internal hernia needed early surgery. Eearly differential diagnosis between adhesion and internal hernia is very important for treatment.

Lee, S, Kim, A, Park, S, Ha, H, CT Differentiation of Internal Hernia from Adhesion in Patients with Small Bowel Obstruction: Characteristic CT Features and Diagnostic Performance.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9005215.html