Podcast 681: Internal Hernias

Emergency Medical Minute

Contributor: Adam Barkin, MD

Educational Pearls:

• Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions
• Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis
• Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension
• Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery
• CT is very >90% sensitivity and specific in diagnosing SBO due to internal hernia
• • Mesenteric swirl is a classic radiology finding
• Treatment with immediate surgical consultation for possible OR bowel decompression
• Start on broad spectrum antibiotics with any signs of sepsis

References

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

Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-717. doi:10.2214/AJR.05.0644

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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