Internal Hernia: Diagnosis and Treatment

Internal hernias account for 5.8% of small bowel obstructions and if untreated have a high mortality rate. Gastric bypass and duodenal switch patients are at risk for such obstructions related to new mesenteric defects. Patients may present with pain, vomiting, abdominal distension, and peritoneal signs, although symptoms may be vague when the bowel intermittently incarcerates and then reduces. Because of altered bariatric anatomy, plain films may not detect internal hernia bowel obstructions. Contrast computed tomography (CT) is the test of choice and may show saclike masses of bowel or a mesenteric “swirl.” Definitive diagnosis and treatment is via diagnostic laparoscopy or laparotomy in selected cases.