Podcast 681: Internal Hernias

<p><strong>Contributor:  Adam Barkin, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">CT is very >90% sensitivity and specific in diagnosing SBO due to internal hernia</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Mesenteric swirl is a classic radiology finding</span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Treatment with immediate surgical consultation for possible OR bowel decompression</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Start on broad spectrum antibiotics with any signs of sepsis</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Lanzetta MM, Masserelli A, Addeo G, et al. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Acta Biomed. 2019;90(5-S):20-37. Published 2019 Apr 24. doi:10.23750/abm.v90i5-S.8344</span></p> <p><span style="font-weight: 400;">Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3)