James Reza F. Fernandez MD, MS, Presenter: Nothing to Disclose

Hooman Djaladat MD, Abstract Co-Author: Nothing to Disclose

Kamran Movassaghi, Abstract Co-Author: Nothing to Disclose

Vinay Anant Duddalwar MD, FRCR, Abstract Co-Author: Research Grant, General Electric Company

Post-cystectomy hernias, designated as incisional or para-stomal depending on whether an ileal conduit or neobladder is constructed, are not uncommon complications of surgery.  Radiologists sometimes under-report such hernias for a variety of reasons, including small size (<1 cm) or, in the case of parastomal hernias, attributing them to normal post-operative change.  In addition, some hernias appreciated on clinical exam are not identified during cross-sectional imaging as they may reduce at the time of the scan.   This project was aimed to identify what types of hernias were missed, the hernia defect sizes, and correlation with clinical exam findings to identify occult hernias which were not identified at the time of the scan.  The ultimate goal was to identify the cause of under-reporting hernias, and to adjust scanning protocols to maximize sensitivity for detecting hernias.  

Approximately 18 out of 401 patients were found to have parastomal hernias postoperatively.  Another 3 were found to have clinical evidence of parastomal hernias, without corresponding cross-sectional imaging findings. Another 122 patients were found to have clinical evidence of incisional hernias, of which 51 were not seen radiographically.  

Two changes were implemented as a result of this: 1) Protocol for post-cystectomy patient surveillance imaging of the abdomen and pelvis is now performed during valsalva to maximize hernia manifestation 2) Radiologists were notified of the study findings, and educated expected post-surgical stoma formation findings, and encouraged to report any fascial defects > 1 cm along incision lines given their propensity to enlarge over time 

401 post-cystectomy patient CT scans of the abdomen and pelvis, for which reports did not have any mention of post-operative hernias (other hernias, including hiatal, umbilical, or inguinal, were not excluded), were reviewed retrospectively for presence of hernias.  Any hernias identified were then analyzed for hernia contents and abdominal wall defect size.

Fernandez, J, Djaladat, H, Movassaghi, K, Duddalwar, V, Post-Cystectomy Hernias: Lessons Learned in Appropriate Reporting and Detection.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001510.html