Download PDF
CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2020; 3(S 01): S35-S48
DOI: 10.1055/s-0040-1715772
Review Article

Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective

Argha Chatterjee
1   Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
,
Rochita V. Ramanan
2   Department of Radiology, Apollo Hospital Chennai, Chennai, India
,
Sumit Mukhopadhyay
1   Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Postoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.

Keywords

internal hernia - incisional hernia - computed tomography


Publication History

Article published online:
27 August 2020

© 2020. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Johnson EE, Simpson AN, Harvey JB, Simpson KN. Bariatric surgery implementation trends in the USA from 2002 to 2012. Implement Sci 2016; 11 (01) 21
    CrossrefPubMedGoogle Scholar
  • 2 Ahmed AR, Rickards G, Husain S, Johnson J, Boss T, O’Malley W. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2007; 17 (12) 1563-1566
    CrossrefPubMedGoogle Scholar
  • 3 Garza Jr E, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg 2004; 188 (06) 796-800
    CrossrefPubMedGoogle Scholar
  • 4 Karila-Cohen P, Cuccioli F, Tammaro P. et al. Contribution of computed tomographic imaging to the management of acute abdominal pain after gastric bypass: correlation between radiological and surgical findings. Obes Surg 2017; 27 (08) 1961-1972
    CrossrefPubMedGoogle Scholar
  • 5 Carucci LR, Turner MA, Shaylor SD. Internal hernia following Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of radiographic findings at small-bowel examination. Radiology 2009; 251 (03) 762-770
    CrossrefPubMedGoogle Scholar
  • 6 Lockhart ME, Tessler FN, Canon CL. et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol 2007; 188 (03) 745-750
    CrossrefPubMedGoogle Scholar
  • 7 Hongo N, Mori H, Matsumoto S, Okino Y, Takaji R, Komatsu E. Internal hernias after abdominal surgeries: MDCT features. Abdom Imaging 2011; 36 (04) 349-362
    CrossrefPubMedGoogle Scholar
  • 8 Furukawa A, Yamasaki M, Furuichi K. et al. Helical CT in the diagnosis of small bowel obstruction. Radiographics 2001; 21 (02) 341-355
    CrossrefPubMedGoogle Scholar
  • 9 Doishita S, Takeshita T, Uchima Y. et al. Internal hernias in the era of multidetector CT: Correlation of imaging and surgical findings. Radiographics 2016; 36 (01) 88-106
    CrossrefPubMedGoogle Scholar
  • 10 Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 2014; 270 (02) 327-341
    CrossrefPubMedGoogle Scholar
  • 11 Fridman A, Moon R, Cozacov Y. et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg 2013; 217 (04) 614-620
    CrossrefPubMedGoogle Scholar
  • 12 Scheirey CD, Scholz FJ, Shah PC, Brams DM, Wong BB, Pedrosa M. Radiology of the laparoscopic Roux-en-Y gastric bypass procedure: conceptualization and precise interpretation of results. Radiographics 2006; 26 (05) 1355-1371
    CrossrefPubMedGoogle Scholar
  • 13 Ahmed AR, Rickards G, Johnson J, Boss T, O’Malley W. Radiological findings in symptomatic internal hernias after laparoscopic gastric bypass. Obes Surg 2009; 19 (11) 1530-1535
    CrossrefPubMedGoogle Scholar
  • 14 Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003; 13 (03) 350-354
    CrossrefPubMedGoogle Scholar
  • 15 Iannuccilli JD, Grand D, Murphy BL, Evangelista P, Roye GD, Mayo-Smith W. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol 2009; 64 (04) 373-380
    CrossrefPubMedGoogle Scholar
  • 16 Ximenes MAS, Baroni RH, Trindade RMC. et al. Petersen’s hernia as a complication of bariatric surgery: CT findings. Abdom Imaging 2011; 36 (02) 126-129
    CrossrefPubMedGoogle Scholar
  • 17 Alkhoury F, Martin J. Case report: complex retroperitoneal herniation after abdominoperineal resection. Int J Surg Case Rep 2012; 3 (12) 584-586
    CrossrefPubMedGoogle Scholar
  • 18 Regan JP, Cho ES, Flowers JL. Small bowel obstruction after laparoscopic donor nephrectomy. Surg Endosc 2003; 17 (01) 108-110
    CrossrefPubMedGoogle Scholar
  • 19 Milosevic I, Dorion H, Ricchiuti D. Incarcerated retroperitoneal hernia following total extraperitoneal laparoscopic radical nephrectomy. JSLS 2011; 15 (03) 424-426
    CrossrefPubMedGoogle Scholar
  • 20 Stubbart JR, Merkley M. Bowel entrapment within pelvic fractures: a case report and review of the literature. J Orthop Trauma 1999; 13 (02) 145-148
    CrossrefPubMedGoogle Scholar
  • 21 Lubat E, Gordon RB, Birnbaum BA, Megibow AJ. CT diagnosis of posterior perineal hernia. AJR Am J Roentgenol 1990; 154 (04) 761-762
    CrossrefPubMedGoogle Scholar
  • 22 Upreti L, Kumar A, Upreti L. Congenital perineal hernia : radiographic findings and role of imaging in diagnosis. Indian J Radiol Imaging 2019; 11 (04) 217-218
    Google Scholar
  • 23 Wong KW, Lai TC, Ng AT. et al. Anterior perineal hernia after anterior exenteration. Asian J Urol 2017; 4 (04) 253-255
    CrossrefPubMedGoogle Scholar
  • 24 Balla A, Batista Rodríguez G, Buonomo N. et al. Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech Coloproctol 2017; 21 (05) 329-336
    CrossrefPubMedGoogle Scholar
  • 25 Musters GD, Buskens CJ, Bemelman WA, Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 2014; 57 (09) 1129-1139
    CrossrefPubMedGoogle Scholar
  • 26 Sayers AE, Patel RK, Hunter IA. Perineal hernia formation following extralevator abdominoperineal excision. Colorectal Dis 2015; 17 (04) 351-355
    CrossrefPubMedGoogle Scholar
  • 27 Sayers AE, Lee MJ, Smart N, Fearnhead NS. NASBO Steering Group. Optimizing collaborator recruitment and maintaining engagement via social media during large multicentre studies: lessons learned from the National Audit of Small Bowel Obstruction (NASBO). Colorectal Dis 2018; 20 (12) 1142-1150
    CrossrefPubMedGoogle Scholar
  • 28 Bertrand K, Lefevre JH, Creavin B, et al. The management of perineal hernia following abdomino-perineal excision for cancer. Hernia 2019
  • 29 Pulikkottil BJ, Pezeshk RA, Daniali LN, Bailey SH, Mapula S, Hoxworth RE. Lateral abdominal wall defects: the importance of anatomy and technique for a successful repair. Plast Reconstr Surg Glob Open 2015; 3 (08) e481
    CrossrefPubMedGoogle Scholar
  • 30 Parikh KR, Al-Hawary M, Millet JD, Burney R, Finks J, Maturen K. Incisional hernia repair: what the radiologist needs to know. AJR Am J Roentgenol 2017; 209 (06) 1239-1246
    CrossrefPubMedGoogle Scholar
  • 31 Basta MN, Kozak GM, Broach RB. et al. Can we predict incisional hernia?: development of a surgery-specific decision-support interface. Ann Surg 2019; 270 (03) 544-553
    CrossrefPubMedGoogle Scholar
  • 32 Lee L, Abou-Khalil M, Liberman S, Boutros M, Fried GM, Feldman LS. Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis. Surg Endosc 2017; 31 (12) 5083-5093
    CrossrefPubMedGoogle Scholar
  • 33 Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg 2017; 17 (01) 19
    CrossrefPubMedGoogle Scholar
  • 34 Emby DJ, Aoun G. CT technique for suspected anterior abdominal wall hernia. AJR Am J Roentgenol 2003; 181 (02) 431-433
    CrossrefPubMedGoogle Scholar
  • 35 Christy MR, Apostolides J, Rodriguez ED, Manson PN, Gens D, Scalea T. The component separation index: a standardized biometric identity in abdominal wall reconstruction. Eplasty 2012; 12: e17
    PubMedGoogle Scholar
  • 36 Levi B, Zhang P, Lisiecki J. et al. Use of morphometric assessment of body composition to quantify risk of surgical-site infection in patients undergoing component separation ventral hernia repair. Plast Reconstr Surg 2014; 133 (04) 559e-566e
    CrossrefPubMedGoogle Scholar
  • 37 Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. Radiographics 2005; 25 (06) 1501-1520
    CrossrefPubMedGoogle Scholar
  • 38 Cheung M-T, Chia N-H, Chiu W-Y. Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 2001; 44 (02) 266-270
    CrossrefPubMedGoogle Scholar
  • 39 Rondelli F, Reboldi P, Rulli A. et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009; 24 (05) 479-488
    CrossrefPubMedGoogle Scholar
  • 40 El Mouhadi S, Tourabi C, Cazejust J, Azizi L, Menu Y, Arrivé L. CT and MRI features of ileostomies. AJR Am J Roentgenol 2011; 196 (03) 577-584
    CrossrefPubMedGoogle Scholar
  • 41 Cingi A, Cakir T, Sever A, Aktan AO. Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 2006; 49 (10) 1559-1563
    CrossrefPubMedGoogle Scholar
  • 42 Sjödahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma. Br J Surg 1988; 75 (04) 339-341
    CrossrefPubMedGoogle Scholar
  • 43 Ortiz H, Sara MJ, Armendariz P, de Miguel M, Marti J, Chocarro C. Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall?. Int J Colorectal Dis 1994; 9 (02) 65-67
    CrossrefPubMedGoogle Scholar
  • 44 Holihan JL, Chen JS, Greenberg J. et al. Incidence of port-site hernias: a survey and literature review. Surg Laparosc Endosc Percutan Tech 2016; 26 (06) 425-430
    CrossrefPubMedGoogle Scholar
  • 45 Owens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011; 9 (04) 218-224
    CrossrefPubMedGoogle Scholar
  • 46 Clark LH, Soliman PT, Odetto D. et al. Incidence of trocar site herniation following robotic gynecologic surgery. Gynecol Oncol 2013; 131 (02) 400-403
    CrossrefPubMedGoogle Scholar
  • 47 Hindman NM, Kang S, Parikh MS. Common postoperative findings unique to laparoscopic surgery. Radiographics 2014; 34 (01) 119-138
    CrossrefPubMedGoogle Scholar
  • 48 Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg 2004; 139 (11) 1248-1256
    CrossrefPubMedGoogle Scholar