Question:

In patients who have undergone Roux-En-Y gastric bypass, the most common locations for internal hernias to occur include: (Select all that apply)
1. Posterior to the Roux limb
2. Anterior to the Roux limb
3. Small bowel defect near jejunojejunostomy site
4. Mesenteric defect of transverse mesocolon
5. Mesenteric defect of descending colon





Answer:

The correct answers for the question "In patients who have undergone Roux-En-Y gastric bypass, the most common locations for internal hernias to occur include: (Select all that apply)" are:

1. Posterior to the Roux limb

3. Small bowel defect near jejunojejunostomy site

4. Mesenteric defect of transverse mesocolon



Explanation

1. This has been shown to be a common site of internal hernia repair. (In Roux-En-Y gastric bypass patients, internal hernias can be found in three potential locations: the small bowel defect found at the jejunojejunostomy site, posterior to the Roux limb (Peterson type), and most commonly at the opening in the transverse mesocolon through which the Roux limb is connected to the newly formed gastric pouch)

2. This has not been shown to be a common site of internal hernia. (In Roux-En-Y gastric bypass patients, internal hernias can be found in three potential locations: the small bowel defect found at the jejunojejunostomy site, posterior to the Roux limb (Peterson type), and most commonly at the opening in the transverse mesocolon through which the Roux limb is connected to the newly formed gastric pouch)

3. This has been shown to be a common site of internal hernia. (In Roux-En-Y gastric bypass patients, internal hernias can be found in three potential locations: the small bowel defect found at the jejunojejunostomy site, posterior to the Roux limb (Peterson type), and most commonly at the opening in the transverse mesocolon through which the Roux limb is connected to the newly formed gastric pouch)

4. This has been shown to be a common site of internal hernia. (In Roux-En-Y gastric bypass patients, internal hernias can be found in three potential locations: the small bowel defect found at the jejunojejunostomy site, posterior to the Roux limb (Peterson type), and most commonly at the opening in the transverse mesocolon through which the Roux limb is connected to the newly formed gastric pouch)

5. This has not been shown to be a common site of internal hernia. (In Roux-En-Y gastric bypass patients, internal hernias can be found in three potential locations: the small bowel defect found at the jejunojejunostomy site, posterior to the Roux limb (Peterson type), and most commonly at the opening in the transverse mesocolon through which the Roux limb is connected to the newly formed gastric pouch)



From the manuscript:
Importance of CT in Evaluating Internal Hernias after Roux-en-Y Gastric Bypass Surgery
Radiology Case. 2009 Jun; 3(6):34-37


This article belongs to the GI section.




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From the manuscript

Importance of CT in Evaluating Internal Hernias after Roux-en-Y Gastric Bypass Surgery

Free full text article: Importance of CT in Evaluating Internal Hernias after Roux-en-Y Gastric Bypass Surgery

Abstract
As the incidence of obesity increases, laparoscopic Roux-en-Y gastric bypass (REYGB) surgery has become a surgical option for many patients. Although the laparoscopic Roux-en Y procedure has been shown to reduce weight and improve diabetes, hyperlipidemia, hypertension and sleep apnea, it is not without significant risks, as more than 10% of patients who undergo this procedure have postoperative GI complications. This is a case of a 51 year old man who presented with diffuse abdominal pain one month status-post Roux-en-Y gastric bypass. CT imaging proved to be crucial in the diagnosis of this pathology with small bowel volvulus and ischemia. We review some key CT findings that can aid clinicians in diagnosing internal hernias since this complication is often misdiagnosed and have a mortality rate of more than 50%.






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