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Abstract
Internal hernia (IH)-related surgical acute abdomen is not well understood because of the rarity of cases and underdiagnosis. This study was performed to further understand the clinicopathological features and multi-detector computed tomography (MDCT) findings of IH in cases confirmed by surgery. In all, 51 patients with a definite diagnosis of IH confirmed during surgical exploration from Feb. 2012 to Feb. 2018 in our hospital were included in this research. Medical records, including MDCT images and intra-operative findings, were collected retrospectively. In all, 39 and 12 cases were categorized as adhesive IH (76.5%) and non-adhesive IH (23.5%), respectively. Among the patients with adhesive IH, 73% had a history of abdominal or pelvic surgery. Additionally, the mesentery was the most common component of adhesive bands (64.1%). Congenital peritoneal abnormalities and gastrointestinal reconstruction were the main causes of non-adhesive IH.As a specific sign, the fat notch sign was much more common in adhesive IH than in non-adhesive IH (P = 0.023). Bowel wall thickening (P = 0.041), abnormal bowel wall enhancement (P = 0.006) and twisted bowels with the vessel swirl sign (P = 0.004) were indicators of bowel necrosis. Among all of the cases of IH, 34 (66.7%) were complicated by bowel necrosis, and 1 patient died. In conclusion, non-adhesive IH has different clinicopathological features and MDCT findings from those of adhesive IH. MDCT is a useful tool with high sensitivity for confirming IH and may help to guide the early treatment of IH.
Highlights
(23.5%) patients were classified as having adhesive IH and non-adhesive IH, respectively, in this study
34 (66.7%) cases were complicated by bowel necrosis, and 1 patient died
In one previous study on adhesive IH, 76.5% (26 out of 34) of patients had a history of surgery[4]
Summary
(23.5%) patients were classified as having adhesive IH and non-adhesive IH, respectively, in this study. Of the 39 patients with adhesive IH, 24(61.5%) had a history of abdominal or (and) pelvic surgery. All patients had various degrees of abdominal pain. Other common clinical symptoms included abdominal distension and nausea/ vomiting. 60–83%, 53.3–66.7%, and 28.6–54.2% of patients with different categories of IH suffered acute bowel obstruction, peritonitis and bowel necrosis. 34 (66.7%) cases were complicated by bowel necrosis, and 1 patient died. The rate of bowel necrosis in the secondary adhesive IH (54.2%) group was higher than that in the other group
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